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General NPI Number Information
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NPI Number | 1033863675
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Entity Type | Organization
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Legal Business Name | IVY COUNSELING SOLUTIONS LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 25088 W 8 MILE RD APT 702
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4054
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Country | US
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Telephone | 248-320-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 25088 W 8 MILE RD APT 702
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4054
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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 | SOLE MBR / OWNER
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Name | JIMMY IVY
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Credential | LMSW
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Telephone | 248-320-4376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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