Provider Demographics
NPI:1083855571
Name:CHESTNUT HILL COUNSELING INC.
Entity Type:Organization
Organization Name:CHESTNUT HILL COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:DEFRANCIS
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-331-3867
Mailing Address - Street 1:8200 E JEFFERSON AVE APT 1911
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3932
Mailing Address - Country:US
Mailing Address - Phone:313-331-3867
Mailing Address - Fax:313-331-3867
Practice Address - Street 1:8200 E JEFFERSON AVE APT 1911
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3932
Practice Address - Country:US
Practice Address - Phone:313-331-3867
Practice Address - Fax:313-331-3867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010613711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON98530Medicare PIN