Provider Demographics
NPI:1275170359
Name:POSITIVE CHANGE COUNSELING PLLC.
Entity Type:Organization
Organization Name:POSITIVE CHANGE COUNSELING PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-808-5706
Mailing Address - Street 1:17215 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2622
Mailing Address - Country:US
Mailing Address - Phone:313-808-5706
Mailing Address - Fax:
Practice Address - Street 1:18620 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2667
Practice Address - Country:US
Practice Address - Phone:313-356-6673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty