Provider Demographics
NPI:1073379525
Name:COMPASSIONATE COUNSELING CARE AND SERVICES
Entity Type:Organization
Organization Name:COMPASSIONATE COUNSELING CARE AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:313-433-3267
Mailing Address - Street 1:18636 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4015
Mailing Address - Country:US
Mailing Address - Phone:313-433-3267
Mailing Address - Fax:
Practice Address - Street 1:18636 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4015
Practice Address - Country:US
Practice Address - Phone:313-433-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSIONATE COUNSELING CARE AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children