=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417621491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPOSEFUL INTENTIONS COUNSELING CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2021
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6199 MILLER RD STE A
-----------------------------------------------------
City | SWARTZ CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48473-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-207-5759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6199 MILLER RD STE A
-----------------------------------------------------
City | SWARTZ CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48473-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-207-5759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC
-----------------------------------------------------
Name | LINDA B SPAINE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 248-470-5791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------