Provider Demographics
NPI:1720529779
Name:RADICAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:RADICAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANNISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:269-692-5321
Mailing Address - Street 1:8655 WHITNEYVILLE CT SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9785
Mailing Address - Country:US
Mailing Address - Phone:269-692-5321
Mailing Address - Fax:269-312-7328
Practice Address - Street 1:8655 WHITNEYVILLE CT SE
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:MI
Practice Address - Zip Code:49302-9785
Practice Address - Country:US
Practice Address - Phone:269-692-5321
Practice Address - Fax:269-312-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016125103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty