Healthcare Provider Details

I. General information

NPI: 1619776887
Provider Name (Legal Business Name): MOXIE COUNSELING CENTER OF MICHIGAN PLCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 UNION LAKE RD
COMMERCE TOWNSHIP MI
48382-3555
US

IV. Provider business mailing address

2559 UNION LAKE RD
COMMERCE TOWNSHIP MI
48382-3555
US

V. Phone/Fax

Practice location:
  • Phone: 248-705-2885
  • Fax:
Mailing address:
  • Phone: 248-705-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MEGAN VANSICKLE
Title or Position: OWNER/THERAPIST
Credential: LMSW
Phone: 248-705-2885