Provider Demographics
NPI:1598911158
Name:COMMUNITY COUNSELING CENTER
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-650-9193
Mailing Address - Street 1:1460 WALTON BLVD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1768
Mailing Address - Country:US
Mailing Address - Phone:248-650-9193
Mailing Address - Fax:248-650-9868
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 30
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-650-9193
Practice Address - Fax:248-650-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty