Provider Demographics
NPI:1093483430
Name:COLLECTIVE WELLNESS COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:COLLECTIVE WELLNESS COUNSELING AND CONSULTING
Other - Org Name:COLLECTIVE WELLNESS COUNSELING AND CONSULTING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:810-328-3574
Mailing Address - Street 1:PO BOX 981065
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-1065
Mailing Address - Country:US
Mailing Address - Phone:810-328-3574
Mailing Address - Fax:
Practice Address - Street 1:108 S ADAMS ST # 981065
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5459
Practice Address - Country:US
Practice Address - Phone:810-328-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLECTIVE WELLNESS COUNSELING AND CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty