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General NPI Number Information
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NPI Number | 1386926624
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Entity Type | Organization
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Legal Business Name | ESSENTIAL COUNSELING & THERAPUTIC SERVICES
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 3984 COMMONWEALTH ST
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City | DETROIT
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State | MI
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Zip | 48208-2574
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Country | US
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Telephone | 248-705-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 3984 COMMONWEALTH ST
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City | DETROIT
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State | MI
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Zip | 48208-2574
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Country | US
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Telephone | 248-705-0604
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | RAESHAWNDRA CHEIRIE JETT
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Credential | MSW
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Telephone | 248-705-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 886475116
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License Number State | MI
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