Healthcare Provider Details

I. General information

NPI: 1972399350
Provider Name (Legal Business Name): THE CONNECTED COLLECTIVE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 STADIUM DR STE 100
KALAMAZOO MI
49009-3022
US

IV. Provider business mailing address

6120 STADIUM DR STE 100
KALAMAZOO MI
49009-3022
US

V. Phone/Fax

Practice location:
  • Phone: 269-366-0650
  • Fax: 269-762-5957
Mailing address:
  • Phone: 269-366-0650
  • Fax: 269-762-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH GOOD
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC, LMFT
Phone: 269-808-8059