Provider Demographics
NPI:1225448095
Name:FELLOWSHIP COUNSELING AND LIFE COACHING, LLC
Entity Type:Organization
Organization Name:FELLOWSHIP COUNSELING AND LIFE COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HIRN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-786-4733
Mailing Address - Street 1:1100 LUDINGTON
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1297
Mailing Address - Country:US
Mailing Address - Phone:906-786-4733
Mailing Address - Fax:906-786-4733
Practice Address - Street 1:1100 LUDINGTON
Practice Address - Street 2:SUITE 306
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1297
Practice Address - Country:US
Practice Address - Phone:906-786-4733
Practice Address - Fax:906-786-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016840251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health