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General NPI Number Information
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NPI Number | 1972399350
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Entity Type | Organization
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Legal Business Name | THE CONNECTED COLLECTIVE WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 6120 STADIUM DR STE 100
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City | KALAMAZOO
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State | MI
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Zip | 49009-3022
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Country | US
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Telephone | 269-366-0650
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Fax | 269-762-5957
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Provider Business Mailing Address
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Address Line | 6120 STADIUM DR STE 100
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City | KALAMAZOO
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State | MI
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Zip | 49009-3022
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Country | US
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Telephone | 269-366-0650
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Fax | 269-762-5957
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | SARAH GOOD
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Credential | LPC, LMFT
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Telephone | 269-808-8059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 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 #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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