Provider Demographics
NPI:1093711459
Name:COMPREHENSIVE COUNSELING CENTER PC
Entity Type:Organization
Organization Name:COMPREHENSIVE COUNSELING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:V
Authorized Official - Last Name:LINGNURKAR MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-558-6000
Mailing Address - Street 1:11885 E 12 MILE RD
Mailing Address - Street 2:STE. 201A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3474
Mailing Address - Country:US
Mailing Address - Phone:586-558-6000
Mailing Address - Fax:586-558-6679
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:STE. 201A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-558-6000
Practice Address - Fax:586-558-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0000000000261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910346OtherBLUE CROSS/BLUE SHIELD ID
MI338940OtherBLUE CARE NETWORK ID
MI338940OtherBLUE CARE NETWORK ID
MI10436Medicare UPIN