Provider Demographics
NPI:1558129551
Name:JOURNEY TO LIFE
Entity Type:Organization
Organization Name:JOURNEY TO LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-648-0071
Mailing Address - Street 1:22725 GREATER MACK AVE STE B301
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2048
Mailing Address - Country:US
Mailing Address - Phone:568-648-0071
Mailing Address - Fax:586-261-5225
Practice Address - Street 1:15734 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2716
Practice Address - Country:US
Practice Address - Phone:586-625-3926
Practice Address - Fax:586-261-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)