Healthcare Provider Details

I. General information

NPI: 1417686155
Provider Name (Legal Business Name): ANCHOR OF HOPE AND HARMONY COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22750 WOODWARD AVE STE 208
FERNDALE MI
48220-1753
US

IV. Provider business mailing address

16618 GREENLAWN ST
DETROIT MI
48221-4912
US

V. Phone/Fax

Practice location:
  • Phone: 248-721-9886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LOLITIA MEDLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-850-6906