Healthcare Provider Details

I. General information

NPI: 1891961116
Provider Name (Legal Business Name): EASTSIDE COUNSELING AND CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 10/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MERRIWEATHER RD
GROSSE POINTE FARMS MI
48236-3533
US

IV. Provider business mailing address

209 MERRIWEATHER RD
GROSSE POINTE FARMS MI
48236-3533
US

V. Phone/Fax

Practice location:
  • Phone: 313-516-3998
  • Fax:
Mailing address:
  • Phone: 313-516-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801015769
License Number StateMI

VIII. Authorized Official

Name: MR. RANDALL FIELDER VORHEES
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 313-516-3998