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General NPI Number Information
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NPI Number | 1063393692
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Entity Type | Organization
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Legal Business Name | IMPACT COUNSELING PARTNERS OF MICHIGAN, LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 32231 SCHOOLCRAFT RD STE 208
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City | LIVONIA
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State | MI
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Zip | 48150-4312
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Country | US
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Telephone | 734-266-6800
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Fax | 734-266-6015
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Provider Business Mailing Address
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Address Line | 38086 LANTERN HILL CT
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-2896
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Country | US
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Telephone | 248-470-7004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA STAFFORD
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Credential | LMSW
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Telephone | 248-470-7004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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