Healthcare Provider Details

I. General information

NPI: 1356648679
Provider Name (Legal Business Name): HEALING HEARTS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 W HAMLIN RD
ROCHESTER HILLS MI
48309-3312
US

IV. Provider business mailing address

1693 W HAMLIN RD
ROCHESTER HILLS MI
48309-3312
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-2999
  • Fax: 248-299-2994
Mailing address:
  • Phone: 248-299-2999
  • Fax: 248-299-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010522
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6401010522
License Number StateMI

VIII. Authorized Official

Name: MARY C TEACHOUT
Title or Position: DIRECTOR
Credential: MA, LPC, NCC
Phone: 248-299-2999