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General NPI Number Information
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NPI Number | 1669920344
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Entity Type | Organization
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Legal Business Name | FLOURISH CENTER FOR CULTIVATING HUMAN POTENTIAL
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 2301 E MICHIGAN AVE STE 214
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City | JACKSON
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State | MI
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Zip | 49202-3765
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Country | US
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Telephone | 517-745-8682
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Fax | 517-513-6536
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Provider Business Mailing Address
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Address Line | 2301 E MICHIGAN AVE STE 214
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City | JACKSON
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State | MI
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Zip | 49202-3765
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Country | US
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Telephone | 517-745-8682
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Fax | 517-513-6536
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MRS. KORAH HOFFMAN
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Credential | LMSW, MPA
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Telephone | 517-745-8682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801097448
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License Number State | MI
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