Provider Demographics
NPI:1093256646
Name:WELLSPRING HEALING CENTER, LLC
Entity Type:Organization
Organization Name:WELLSPRING HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR & PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DELACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-544-1612
Mailing Address - Street 1:704 N CONGRESS ST
Mailing Address - Street 2:3
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3318
Mailing Address - Country:US
Mailing Address - Phone:765-426-1313
Mailing Address - Fax:
Practice Address - Street 1:704 N CONGRESS ST
Practice Address - Street 2:3
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3318
Practice Address - Country:US
Practice Address - Phone:765-426-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty