MEDICARE: ELSHADDAI COUNSELING & CONSULTATION SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	L1576978	MI
2	101YP2500X	Professional Counselor	L1532194	MI

General Provider Information

NPI Number	:	1033340526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSHADDAI COUNSELING & CONSULTATION SERVICES

Provider Business Mailing Address
First Line	:	105 E FRONT ST
Second Line	:	SUITE 204
City	:	MONROE
State	:	MI
Zip	:	48161-2477
Country	:	US
Telephone Number	:	734-240-0372
Fax Number	:	734-481-0090

Provider Business Practice Location Address
First Line	:	105 E FRONT ST
Second Line	:	SUITE 204
City	:	MONROE
State	:	MI
Zip	:	48161-2477
Country	:	US
Telephone Number	:	734-240-0372
Fax Number	:	734-481-0090

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. VICTORIA BROWN
Credential	:	MA PHDC
Telephone Number	:	734-240-0372

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/31/2009

Similar Medicare Providers

1205964459 — EL SHADDAI COUNSELING & CONSULTATION SERVICES
Practice Location Address:

105 E FRONT ST , SUITE 204
MONROE, MI
48161-2477

Practice Phone: 734-240-0372
Practice Fax: 734-240-0372

1447482393 — MRS. LORI RENEE VARGO CSW
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1700018678 — MS. VICTORIA BROWN MA PHDC
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1972501872 — DR. MARIO J SEBASTIANELLI MD
Practice Location Address:

1416 MONROE AVE , STE 206
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1194723007 — MARIO J. SEBASTIANELLI, MD PC
Practice Location Address:

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1922093749 — DR. EUGENE A TURCHETTI MD
Practice Location Address:

1416 MONROE AVE
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