Provider Demographics
NPI:1790576551
Name:THE HEALING VINE, LLC
Entity type:Organization
Organization Name:THE HEALING VINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-331-0690
Mailing Address - Street 1:6909 WHITBY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2056
Mailing Address - Country:US
Mailing Address - Phone:734-331-0690
Mailing Address - Fax:
Practice Address - Street 1:6909 WHITBY ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2056
Practice Address - Country:US
Practice Address - Phone:734-331-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty