Healthcare Provider Details

I. General information

NPI: 1851448146
Provider Name (Legal Business Name): GROWTH WORKS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 S MAIN STREET
PLYMOUTH MI
48170
US

IV. Provider business mailing address

271 S MAIN STREET
PLYMOUTH MI
48170
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-4095
  • Fax: 734-455-1254
Mailing address:
  • Phone: 734-455-4095
  • Fax: 734-455-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4301043592
License Number StateMI

VIII. Authorized Official

Name: MRS. DEANNA WHEELER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 248-216-6451