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General NPI Number Information
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NPI Number | 1205624319
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Entity Type | Organization
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Legal Business Name | THRIVE ROOTS WELLNESS
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 11358 CANAL RD APT 203
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1523
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Country | US
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Telephone | 313-978-5947
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Fax |
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Provider Business Mailing Address
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Address Line | 13335 15 MILE RD STE 128
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-4271
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Country | US
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Telephone | 313-552-3440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CARRIECE WILLIAMS
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Credential |
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Telephone | 313-552-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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