Healthcare Provider Details

I. General information

NPI: 1730813239
Provider Name (Legal Business Name): HIVE WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W. GRAND RIVER STE A
OKEMOS MI
48864
US

IV. Provider business mailing address

5778 TRAIL SIDE LN
HAMBURG TWP MI
48189-8162
US

V. Phone/Fax

Practice location:
  • Phone: 734-219-0085
  • Fax:
Mailing address:
  • Phone: 734-732-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LEE MCCLELLAN
Title or Position: OWNER
Credential: LMSW
Phone: 734-732-2518