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General NPI Number Information
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NPI Number | 1679817480
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COUNSELING SERVICES FOR FAMILIES & YOUTH LLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2048 WASHTENAW RD UPPR SUITE
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City | YPSILANTI
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State | MI
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Zip | 48197-1889
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Country | US
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Telephone | 734-748-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 8963 NORTHAMPTON DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-3339
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Country | US
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Telephone | 734-748-0950
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Fax |
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Authorized Official
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Title or Position | LMSW
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Name | KAREN S ZOKAS
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Credential | LMSW
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Telephone | 734-748-0950
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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 | 6801086356
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License Number State | MI
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