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General NPI Number Information
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NPI Number | 1366753477
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Entity Type | Organization
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Legal Business Name | EL SHADDAI COUNSELING & CONSULTATION SERVICES
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 105 E FRONT ST STE 204
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City | MONROE
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State | MI
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Zip | 48161-2160
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Country | US
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Telephone | 734-240-0372
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Fax | 888-277-5583
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Provider Business Mailing Address
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Address Line | 105 E FRONT ST
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City | MONROE
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State | MI
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Zip | 48161-2477
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Country | US
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Telephone | 734-240-0372
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Fax | 888-277-5583
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA BROWN
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Credential | PC
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Telephone | 734-240-0372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 091061
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.0600123
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License Number State | OH
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