Provider Demographics
NPI:1225746969
Name:DOVE OF PEACE CHRISTIAN COUNSELING PLLC
Entity Type:Organization
Organization Name:DOVE OF PEACE CHRISTIAN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRETTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-443-1834
Mailing Address - Street 1:51145 WASHINGTON ST STE H
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2100
Mailing Address - Country:US
Mailing Address - Phone:586-443-1834
Mailing Address - Fax:
Practice Address - Street 1:51145 WASHINGTON ST STE H
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2100
Practice Address - Country:US
Practice Address - Phone:586-443-1834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid