Provider Demographics
NPI:1164605556
Name:INTEGRATIVE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACKSON-MARBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CHT
Authorized Official - Phone:313-499-5947
Mailing Address - Street 1:23770 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3420
Mailing Address - Country:US
Mailing Address - Phone:313-499-5947
Mailing Address - Fax:
Practice Address - Street 1:19678 HARPER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1966
Practice Address - Country:US
Practice Address - Phone:313-499-5947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health