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General NPI Number Information
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NPI Number | 1669823894
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Entity Type | Organization
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Legal Business Name | RADIANT COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 15869 SPUR DR
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City | MACOMB
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State | MI
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Zip | 48042-2214
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Country | US
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Telephone | 586-354-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 15869 SPUR DR
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City | MACOMB
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State | MI
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Zip | 48042-2214
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Country | US
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Telephone | 586-354-3127
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. JENEVE BLEVINS
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Credential | M.A. L.P.C.
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Telephone | 586-354-3127
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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 | 6401013058
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License Number State | MI
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