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General NPI Number Information
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NPI Number | 1033633300
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Entity Type | Organization
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Legal Business Name | CHANGE YOUR DESTINY COUNSELING LLC
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 2000 TOWN CTR STE 1900
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1152
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Country | US
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Telephone | 248-733-5142
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Fax |
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Provider Business Mailing Address
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Address Line | 8913 GABRIEL ST
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City | ROMULUS
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State | MI
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Zip | 48174-4133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | MARLINA BROWN
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Credential |
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Telephone | 313-544-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012941
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License Number State | MI
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