Healthcare Provider Details

I. General information

NPI: 1417562026
Provider Name (Legal Business Name): EVERLASTING LOVE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20218 WOODMONT ST
HARPER WOODS MI
48225-1835
US

IV. Provider business mailing address

20218 WOODMONT ST
HARPER WOODS MI
48225-1835
US

V. Phone/Fax

Practice location:
  • Phone: 586-298-1617
  • Fax:
Mailing address:
  • Phone: 586-298-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. FLORENCE PERRY
Title or Position: ADMINSTRATOR
Credential: LMSW
Phone: 313-258-9795