Healthcare Provider Details

I. General information

NPI: 1043959851
Provider Name (Legal Business Name): AFFILIATED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26862 WOODWARD AVE UNIT 101
ROYAL OAK MI
48067-0958
US

IV. Provider business mailing address

1206 E LINCOLN AVE
ROYAL OAK MI
48067-3452
US

V. Phone/Fax

Practice location:
  • Phone: 248-507-4446
  • Fax:
Mailing address:
  • Phone: 248-678-1146
  • Fax:

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: SALLY LYONS
Title or Position: OWNER
Credential:
Phone: 248-678-1146