Healthcare Provider Details

I. General information

NPI: 1710452271
Provider Name (Legal Business Name): DOWNRIVER PROFESSIONAL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 ROOSEVELT AVE STE 203
ALLEN PARK MI
48101-2583
US

IV. Provider business mailing address

7000 ROOSEVELT AVE STE 203
ALLEN PARK MI
48101-2583
US

V. Phone/Fax

Practice location:
  • Phone: 248-760-3125
  • Fax:
Mailing address:
  • Phone: 248-760-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH NOLAN
Title or Position: OWNER
Credential: LLMSW
Phone: 248-760-3125