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General NPI Number Information
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NPI Number | 1063193233
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Entity Type | Organization
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Legal Business Name | DOWNTOWN WELLNESS PLLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 104 E MAPLE ST
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City | HOLLY
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State | MI
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Zip | 48442-2101
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Country | US
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Telephone | 810-373-9062
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Fax |
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Provider Business Mailing Address
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Address Line | 412 S BROAD ST
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City | HOLLY
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State | MI
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Zip | 48442-1626
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Country | US
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Telephone | 248-894-0824
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/ OWNER
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Name | ASHLEY THOMAS
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Credential | LPC
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Telephone | 248-894-0824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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