Healthcare Provider Details

I. General information

NPI: 1295243293
Provider Name (Legal Business Name): INTEGRITY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17344 W 12 MILE RD STE 206
SOUTHFIELD MI
48076-6321
US

IV. Provider business mailing address

PO BOX 930245
WIXOM MI
48393-0245
US

V. Phone/Fax

Practice location:
  • Phone: 734-829-7573
  • Fax:
Mailing address:
  • Phone: 734-829-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6401012245
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY RICE
Title or Position: OFFICE MANAGER
Credential: LPC
Phone: 734-829-7573