Provider Demographics
NPI:1033372818
Name:COLONIAL WOODS MISSIONARY CHURCH
Entity Type:Organization
Organization Name:COLONIAL WOODS MISSIONARY CHURCH
Other - Org Name:COLONIAL WOODS CHRISTIAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOETZE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CSW
Authorized Official - Phone:810-984-5575
Mailing Address - Street 1:1101 MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5418
Mailing Address - Country:US
Mailing Address - Phone:810-984-5575
Mailing Address - Fax:810-984-6433
Practice Address - Street 1:1101 MILITARY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5418
Practice Address - Country:US
Practice Address - Phone:810-984-5575
Practice Address - Fax:810-984-6433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLONIAL WOODS MISSIONARY CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center