Provider Demographics
NPI:1164293585
Name:OLIVE BRANCH HEALING LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAD-CRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C
Authorized Official - Phone:734-497-3662
Mailing Address - Street 1:511 RIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-8630
Mailing Address - Country:US
Mailing Address - Phone:734-497-3662
Mailing Address - Fax:
Practice Address - Street 1:46820 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5256
Practice Address - Country:US
Practice Address - Phone:734-497-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty