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General NPI Number Information
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NPI Number | 1245619949
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Entity Type | Organization
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Legal Business Name | ENVISION CHANGE COUNSELING & CONSULTING
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 2028 CUMBERLAND RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-3702
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Country | US
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Telephone | 248-294-0825
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 CUMBERLAND RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-3702
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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 | OWNER
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Name | JAMELL JEFFERSON
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Credential | MA, LPC
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Telephone | 248-294-0825
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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 | 6401012241
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License Number State | MI
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