Provider Demographics
NPI:1447213376
Name:BROOKSIDE COUNSELING SRVS, LLC
Entity Type:Organization
Organization Name:BROOKSIDE COUNSELING SRVS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:D'ANNE
Authorized Official - Middle Name:LOVENE
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-552-1030
Mailing Address - Street 1:15565 NORTHLAND DR
Mailing Address - Street 2:STE. 812E
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-552-1030
Mailing Address - Fax:248-552-3041
Practice Address - Street 1:15565 NORTHLAND DR
Practice Address - Street 2:STE. 812E
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-552-1030
Practice Address - Fax:248-552-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010825011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty