Provider Demographics
NPI:1730813239
Name:HIVE WELLNESS COLLECTIVE LLC
Entity type:Organization
Organization Name:HIVE WELLNESS COLLECTIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-732-2518
Mailing Address - Street 1:5778 TRAIL SIDE LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8162
Mailing Address - Country:US
Mailing Address - Phone:734-732-2518
Mailing Address - Fax:
Practice Address - Street 1:2222 W. GRAND RIVER
Practice Address - Street 2:STE A
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:734-219-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty