Healthcare Provider Details

I. General information

NPI: 1790488294
Provider Name (Legal Business Name): ENRICHMENT COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14539 ARCHWOOD ST
VAN NUYS CA
91405-4602
US

IV. Provider business mailing address

14539 ARCHWOOD ST
VAN NUYS CA
91405-4602
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-9261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATEEA MAFFETT
Title or Position: OWNER
Credential:
Phone: 517-507-9261