Provider Demographics
NPI:1477736064
Name:EKONG COUNSELING CENTER
Entity Type:Organization
Organization Name:EKONG COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:RUCKES
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-469-8322
Mailing Address - Street 1:29532 SOUTHFIELD RD
Mailing Address - Street 2:101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2023
Mailing Address - Country:US
Mailing Address - Phone:248-469-8322
Mailing Address - Fax:248-423-4249
Practice Address - Street 1:29532 SOUTHFIELD RD
Practice Address - Street 2:101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2023
Practice Address - Country:US
Practice Address - Phone:248-469-8322
Practice Address - Fax:248-423-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015337261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0898217OtherBCBS