Provider Demographics
NPI:1134282049
Name:JOURNEY THERAPEUTIC COUNSELING
Entity Type:Organization
Organization Name:JOURNEY THERAPEUTIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-398-8085
Mailing Address - Street 1:20300 CIVIC CENTER DR STE 303
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4169
Mailing Address - Country:US
Mailing Address - Phone:248-398-8085
Mailing Address - Fax:
Practice Address - Street 1:20300 CIVIC CENTER DR STE 303
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4169
Practice Address - Country:US
Practice Address - Phone:248-398-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P24890Medicare ID - Type Unspecified