Provider Demographics
NPI:1548851579
Name:POSITVE TRANSFORMATIONS
Entity type:Organization
Organization Name:POSITVE TRANSFORMATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, FLE
Authorized Official - Phone:248-935-5307
Mailing Address - Street 1:155 S MAIN ST UNIT 463127
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48046-7794
Mailing Address - Country:US
Mailing Address - Phone:586-551-2757
Mailing Address - Fax:
Practice Address - Street 1:155 S MAIN ST UNIT 463127
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48046-7794
Practice Address - Country:US
Practice Address - Phone:586-551-2757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENDRA HATHAWAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962961771OtherNPI