MEDICARE: AFTERGLOW COUNSELING, MEDIATION, AND FAMILY SERVICES CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	48104	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	48104	CA
3	101YM0800X	Mental Health Counselor	48104	CA
4	101YP1600X	Pastoral Counselor	48104	CA
5	101YP2500X	Professional Counselor	48104	CA
6	103G00000X	Clinical Neuropsychologist	48104	CA
7	103K00000X	Behavior Analyst	48104	CA
8	104100000X	Social Worker	25894	CA
9	1041C0700X	Clinical Social Worker	25894	CA
10	106H00000X	Marriage & Family Therapist	48104	CA

General Provider Information

NPI Number	:	1194049643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFTERGLOW COUNSELING, MEDIATION, AND FAMILY SERVICES CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-0024
Country	:	US
Telephone Number	:	909-503-7191
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N MAIN ST
Second Line	:	#24
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1372
Country	:	US
Telephone Number	:	909-503-7191
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO/FOUNDER/DIRECTOR
Name	:	DR. BRENDA-JOYCE G. MARKERT-GREEN
Credential	:	DMFT, LMFT
Telephone Number	:	909-503-7191

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	08/07/2015

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