Healthcare Provider Details

I. General information

NPI: 1083476428
Provider Name (Legal Business Name): ENCOMPASS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 OLD HUNTERS RUN
ROCKFORD IL
61114
US

IV. Provider business mailing address

250 MONROE AVE NW STE 400
GRAND RAPIDS MI
49503-2293
US

V. Phone/Fax

Practice location:
  • Phone: 331-575-5035
  • Fax:
Mailing address:
  • Phone: 331-575-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANGELO
Title or Position: OWNER
Credential: LPC
Phone: 331-575-5035