Provider Demographics
NPI:1033340526
Name:ELSHADDAI COUNSELING & CONSULTATION SERVICES
Entity Type:Organization
Organization Name:ELSHADDAI COUNSELING & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA PHDC
Authorized Official - Phone:734-240-0372
Mailing Address - Street 1:105 E FRONT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2477
Mailing Address - Country:US
Mailing Address - Phone:734-240-0372
Mailing Address - Fax:734-481-0090
Practice Address - Street 1:105 E FRONT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2477
Practice Address - Country:US
Practice Address - Phone:734-240-0372
Practice Address - Fax:734-481-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1576978101YP2500X
MIL1532194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty