# PRIME WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851127021
- **Authorized official:** DONTIA WILSON LPC (MANAGER)
- **Authorized official phone:** (419) 508-9566

## Contact information

- **Practice address:** 2727 2ND AVE STE 131, DETROIT, MI 48201-2660
- **Practice address phone:** (419) 508-9566
- **Mailing address:** 2727 2ND AVE STE 131, DETROIT, MI 48201-2660
- **Mailing address phone:** (419) 508-9566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2024
- **Last updated:** 09/12/2024