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General NPI Number Information
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NPI Number | 1659932481
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Entity Type | Organization
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Legal Business Name | INNER FAITH COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | G3163 FLUSHING RD STE 214
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City | FLINT
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State | MI
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Zip | 48504-4365
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Country | US
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Telephone | 810-845-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 5418 BRIGHT CREEK CT
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City | FLINT
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State | MI
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Zip | 48532-2254
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Country | US
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Telephone | 810-845-6465
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR/PSYCHOTHERAPIST
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Name | VALERIE F JACKSON
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Credential | LMSW
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Telephone | 810-845-6465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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