=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528936358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVORTEX WELLNESS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 GODDARD ST
-----------------------------------------------------
City | WYANDOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-846-1498
-----------------------------------------------------
Fax | 248-846-1506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 607 SHELBY ST STE 700
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48226-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-846-1498
-----------------------------------------------------
Fax | 248-846-1506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. LATONYA RENAE MCCOY
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 248-846-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372500000X
-----------------------------------------------------
Taxonomy Name | Chore Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------