Healthcare Provider Details

I. General information

NPI: 1972141406
Provider Name (Legal Business Name): RELIANCE COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 WAYNE RD # 2
ROMULUS MI
48174-1473
US

IV. Provider business mailing address

11126 WAYNE RD # 2
ROMULUS MI
48174-1473
US

V. Phone/Fax

Practice location:
  • Phone: 734-377-8720
  • Fax: 734-527-6183
Mailing address:
  • Phone: 734-377-8720
  • Fax: 734-527-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES A LEE
Title or Position: OWNER
Credential: LMSW, CADC
Phone: 734-377-8720