Provider Demographics
NPI:1558791582
Name:ABOUT FACE CHRISTIAN COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:ABOUT FACE CHRISTIAN COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, PHD, SSW,
Authorized Official - Phone:231-425-4036
Mailing Address - Street 1:239 N JEBAVY DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2910
Mailing Address - Country:US
Mailing Address - Phone:231-425-4036
Mailing Address - Fax:
Practice Address - Street 1:239 N JEBAVY DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2910
Practice Address - Country:US
Practice Address - Phone:231-425-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077151251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health