Healthcare Provider Details

I. General information

NPI: 1679370597
Provider Name (Legal Business Name): HEALTHY HEART COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11648 WHITTIER ST
DETROIT MI
48224-1540
US

IV. Provider business mailing address

12508 LORETTO ST
DETROIT MI
48205-3975
US

V. Phone/Fax

Practice location:
  • Phone: 586-907-5828
  • Fax:
Mailing address:
  • Phone: 586-563-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RAYVON LARNARD SHIPMAN
Title or Position: CEO
Credential: LMSW
Phone: 586-907-5828