Provider Demographics
NPI:1548750623
Name:ARBOR WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:ARBOR WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:EASTMAN
Authorized Official - Last Name:BUZOLITS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-646-0885
Mailing Address - Street 1:2350 WASHTENAW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4526
Mailing Address - Country:US
Mailing Address - Phone:734-743-2828
Mailing Address - Fax:734-527-6075
Practice Address - Street 1:2350 WASHTENAW AVE STE 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4526
Practice Address - Country:US
Practice Address - Phone:734-743-2828
Practice Address - Fax:734-527-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty