=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225967128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWO DOVES WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2026
-----------------------------------------------------
Last Update Date | 05/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36340 UNION LAKE RD APT 201
-----------------------------------------------------
City | HARRISON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48045-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-648-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 W GRAND RIVER AVE STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-648-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. AUDREY R GALLAS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 251-648-1944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------