Provider Demographics
NPI:1154470755
Name:ACCESS CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:ACCESS CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:CAPICCHIONI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LLP
Authorized Official - Phone:248-355-4300
Mailing Address - Street 1:29260 FRANKLIN RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1161
Mailing Address - Country:US
Mailing Address - Phone:248-355-4300
Mailing Address - Fax:248-355-4393
Practice Address - Street 1:29260 FRANKLIN RD
Practice Address - Street 2:SUITE 121
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1161
Practice Address - Country:US
Practice Address - Phone:248-355-4300
Practice Address - Fax:248-355-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012712103TC0700X
MI6301010435261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty