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General NPI Number Information
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NPI Number | 1245673342
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Entity Type | Organization
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Legal Business Name | 1 ON 1 PROFESSIONAL COUNSELING SERVICE PLLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 8965 GRIGGS ST
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City | DETROIT
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State | MI
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Zip | 48204-2643
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Country | US
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Telephone | 313-909-7080
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Fax | 313-933-1370
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Provider Business Mailing Address
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Address Line | 8965 GRIGGS ST
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City | DETROIT
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State | MI
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Zip | 48204-2643
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Country | US
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Telephone | 313-909-7080
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Fax | 313-933-1370
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. GWENDOLYN JOYCE HAYES
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Credential | LPC
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Telephone | 313-909-7080
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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 | 6401011643
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License Number State | MI
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