Provider Demographics
NPI:1609148311
Name:FAMILY MATTERS COUNSELING AND EDUCATIONAL AGENCY LLC
Entity Type:Organization
Organization Name:FAMILY MATTERS COUNSELING AND EDUCATIONAL AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MINGCORIA
Authorized Official - Middle Name:ELEASE
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-410-8352
Mailing Address - Street 1:18140 MEADOWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4514
Mailing Address - Country:US
Mailing Address - Phone:313-410-8352
Mailing Address - Fax:
Practice Address - Street 1:18140 MEADOWOOD AVE
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4514
Practice Address - Country:US
Practice Address - Phone:313-410-8352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health