Provider Demographics
NPI:1497229975
Name:ACTON FAMILY COUNSELING
Entity Type:Organization
Organization Name:ACTON FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFOREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-633-4358
Mailing Address - Street 1:2301 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5148
Mailing Address - Country:US
Mailing Address - Phone:517-206-7879
Mailing Address - Fax:
Practice Address - Street 1:2301 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5148
Practice Address - Country:US
Practice Address - Phone:517-206-7879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401010908Medicaid