Healthcare Provider Details

I. General information

NPI: 1245653195
Provider Name (Legal Business Name): THE COUNSELING CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PARK ST
PLAINWELL MI
49080-1655
US

IV. Provider business mailing address

319 PARK ST
PLAINWELL MI
49080-1655
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-9401
  • Fax: 269-685-9403
Mailing address:
  • Phone: 269-685-9401
  • Fax: 269-685-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096023
License Number StateMI

VIII. Authorized Official

Name: CHERYL PARENTE-ROGGOW
Title or Position: CLINICAL DIRECTOR
Credential: LMSW
Phone: 269-685-9401