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General NPI Number Information
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NPI Number | 1811482664
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Entity Type | Organization
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Legal Business Name | FAMILY, COUPLES & ADOLESCENCE COUNSELING, LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 3525 ELIZABETH LAKE RD STE A
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City | WATERFORD
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State | MI
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Zip | 48328-3087
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Country | US
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Telephone | 313-671-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 3481 CASTLEWOOD CT
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City | WIXOM
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State | MI
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Zip | 48393-1749
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Country | US
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Telephone | 313-671-4002
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Fax | 248-732-7500
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Authorized Official
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Title or Position | OWNER/ MENTAL HEALTH COUNSELOR
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Name | LAJOY HARRIS
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Credential | LPC, NCC,QMHP, ICADC
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Telephone | 313-671-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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