=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316576994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOKORO COUNSELING AND WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2020
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2081 W WILLIAMS CIR
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-629-6989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46036 MICHIGAN AVENUE #183
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-629-6989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MONICA CRAWFORD
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 734-606-9326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------