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General NPI Number Information
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NPI Number | 1790477099
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Entity Type | Organization
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Legal Business Name | CLINICAL HEALING CENTER LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 2 CROCKER BLVD STE 100
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2558
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Country | US
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Telephone | 586-318-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 35181 PLEASANT FARM RD
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City | RICHMOND
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State | MI
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Zip | 48062-4235
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MR. TIMOTHY LEE WEAVER
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Credential | LMSW, CAADC
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Telephone | 586-318-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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