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General NPI Number Information
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NPI Number | 1689078610
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Entity Type | Organization
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Legal Business Name | PROPHETIC SOLUTIONS PROFESSIONAL COUNSELING, PLLC
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 25245 5 MILE RD STE 600
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City | REDFORD
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State | MI
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Zip | 48239-3785
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Country | US
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Telephone | 313-506-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 25245 5 MILE RD STE 700
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City | REDFORD
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State | MI
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Zip | 48239-3701
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Country | US
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Telephone | 313-506-3322
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | CARLA LEWIS-MOORE
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Credential | LMSW
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Telephone | 313-506-3322
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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 | 6801085243
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License Number State | MI
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