Provider Demographics
NPI:1043503394
Name:COSTEA COUNSELING SERVICES
Entity Type:Organization
Organization Name:COSTEA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COSTEA
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:269-343-3871
Mailing Address - Street 1:1011 W MAPLE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1899
Mailing Address - Country:US
Mailing Address - Phone:269-343-3871
Mailing Address - Fax:269-343-3872
Practice Address - Street 1:1011 W MAPLE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1899
Practice Address - Country:US
Practice Address - Phone:269-343-3871
Practice Address - Fax:269-343-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090776251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health