Healthcare Provider Details

I. General information

NPI: 1356185060
Provider Name (Legal Business Name): MONROE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MONROE ST
MONROE MI
48162-2621
US

IV. Provider business mailing address

4909 TANAGER DR
MONROE MI
48161-9644
US

V. Phone/Fax

Practice location:
  • Phone: 734-770-7912
  • Fax: 734-241-0014
Mailing address:
  • Phone: 734-770-7912
  • Fax: 734-241-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW SHEHADEH BUTLER
Title or Position: EMPLOYEE/OWNER
Credential: LMSW
Phone: 734-770-7912