Healthcare Provider Details

I. General information

NPI: 1093483430
Provider Name (Legal Business Name): COLLECTIVE WELLNESS COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S ADAMS ST # 981065
YPSILANTI MI
48197-5459
US

IV. Provider business mailing address

PO BOX 981065
YPSILANTI MI
48198-1065
US

V. Phone/Fax

Practice location:
  • Phone: 810-328-3574
  • Fax:
Mailing address:
  • Phone: 810-328-3574
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATONYA DEMPS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 810-328-3574