Provider Demographics
NPI:1598957656
Name:DIAKONOS COUNSELING & CONSULTATION SERVICE
Entity Type:Organization
Organization Name:DIAKONOS COUNSELING & CONSULTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:517-392-5536
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:STE. 205
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-0451
Mailing Address - Country:US
Mailing Address - Phone:517-629-4723
Mailing Address - Fax:517-629-5366
Practice Address - Street 1:726 AUSTIN AVE
Practice Address - Street 2:STE. 205
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1073
Practice Address - Country:US
Practice Address - Phone:617-629-4723
Practice Address - Fax:517-629-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010005251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2=========OtherPAYEE