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General NPI Number Information
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NPI Number | 1134811227
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Entity Type | Organization
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Legal Business Name | JC FOUNDATIONS VIOLET FLAME ENLIGHTENMENT AND HEALING CENTER LLC
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 25915 HARPER AVE STE A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3770
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Country | US
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Telephone | 313-695-4201
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Fax |
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Provider Business Mailing Address
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Address Line | 25915 HARPER AVE STE A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3770
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Country | US
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Telephone | 313-695-4201
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA COTTRELL
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Credential | MA LPC
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Telephone | 313-695-4201
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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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