Provider Demographics
NPI:1417289299
Name:NORTH LAPEER COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:NORTH LAPEER COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:810-793-4646
Mailing Address - Street 1:5914 N LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-9778
Mailing Address - Country:US
Mailing Address - Phone:810-793-4646
Mailing Address - Fax:810-793-4660
Practice Address - Street 1:5914 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-9778
Practice Address - Country:US
Practice Address - Phone:810-793-4646
Practice Address - Fax:810-793-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008841251S00000X
MI6801013350251S00000X
MI6401001683251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health