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General NPI Number Information
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NPI Number | 1730813239
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Entity Type | Organization
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Legal Business Name | HIVE WELLNESS COLLECTIVE LLC
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2222 W. GRAND RIVER STE A
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 734-219-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 5778 TRAIL SIDE LN
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City | HAMBURG TWP
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State | MI
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Zip | 48189-8162
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Country | US
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Telephone | 734-732-2518
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA LEE MCCLELLAN
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Credential | LMSW
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Telephone | 734-732-2518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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