Healthcare Provider Details

I. General information

NPI: 1003287459
Provider Name (Legal Business Name): BJC COUNSELING AND BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16175 ASBURY PARK
DETROIT MI
48235-3656
US

IV. Provider business mailing address

16715 ASBURY PARK
DETROIT MI
48235
US

V. Phone/Fax

Practice location:
  • Phone: 313-673-1992
  • Fax:
Mailing address:
  • Phone: 313-673-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3891164
License Number StateMI

VIII. Authorized Official

Name: BARBARA CULP
Title or Position: PROFESSIONAL COUNSELOR
Credential: LICENSE COUNSELOR
Phone: 313-673-1992