=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467392902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ETERNAL SOLACE COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2026
-----------------------------------------------------
Last Update Date | 04/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22760 CIVIC CENTER DR
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-7150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-788-6608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26026 TELEGRAPH RD STE 200
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-788-6608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | TEILOR DUNCAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 734-560-8264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------