Healthcare Provider Details

I. General information

NPI: 1437013315
Provider Name (Legal Business Name): HEALING AFTER THE WILDERNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7244 COTTONWOOD KNL
WEST BLOOMFIELD MI
48322-4045
US

IV. Provider business mailing address

7244 COTTONWOOD KNL
WEST BLOOMFIELD MI
48322-4045
US

V. Phone/Fax

Practice location:
  • Phone: 248-915-9372
  • Fax: 248-927-5114
Mailing address:
  • Phone: 248-915-9372
  • Fax: 248-927-5114

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: MICHANDA GANT
Title or Position: OWNER/CEO
Credential: LMSW-C
Phone: 248-915-9372