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General NPI Number Information
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NPI Number | 1457890014
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Entity Type | Organization
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Legal Business Name | HEALING WATERS COUNSELING SERVICES,PLLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 29556 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2021
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Country | US
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Telephone | 248-480-1826
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Fax | 313-521-1902
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Provider Business Mailing Address
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Address Line | 11291 MCKINNEY ST
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City | DETROIT
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State | MI
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Zip | 48224-1114
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Country | US
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Telephone | 248-480-1826
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Fax | 313-521-1902
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY ANGEL MCGHEE
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Credential | MA,LLPC
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Telephone | 248-480-1246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401009379
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License Number State | MI
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