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General NPI Number Information
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NPI Number | 1710644786
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Entity Type | Organization
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Legal Business Name | CONVERGENCE COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 36401 HARPER AVE
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-2957
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Country | US
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Telephone | 586-649-7589
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Fax |
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Provider Business Mailing Address
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Address Line | 46850 TILCH RD
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City | MACOMB
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State | MI
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Zip | 48044-4725
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Country | US
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Telephone | 586-565-0830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH IGNACE
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Credential | LMSW
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Telephone | 586-565-0830
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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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