| Harvest Center For Wellness Llc | |
|
4330 W Davison Detroit MI 48238-3273 | |
| (248) 298-9215 | |
| Not Available |
| Full Name | Harvest Center For Wellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 4330 W Davison, Detroit, Michigan |
| Authorized Official Name and Position | Mellanie Knox (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2482989215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harvest Center For Wellness Llc 4330 W Davison Detroit MI 48238-3273 Ph: (248) 298-9215 | Harvest Center For Wellness Llc 4330 W Davison Detroit MI 48238-3273 Ph: (248) 298-9215 |
| NPI Number | 1093577678 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 01/29/2024 |
| Certification Date | 01/29/2024 |
| Medicare PECOS PAC ID | 9931544707 |
|---|---|
| Medicare Enrollment ID | O20240302000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093577678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Rita Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780152975 PECOS PAC ID: 2567716889 Enrollment ID: I20181126001357 |
| Provider Name | Lia Marie Hollis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699024851 PECOS PAC ID: 7416233507 Enrollment ID: I20200505000825 |
| Provider Name | Mellanie Knox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609207042 PECOS PAC ID: 4385089044 Enrollment ID: I20240304002877 |
| Provider Name | Alfonzo Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407274848 PECOS PAC ID: 8527403146 Enrollment ID: I20240305001534 |
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