Provider Demographics
NPI:1619411386
Name:STILL WATERS CHRISTIAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:STILL WATERS CHRISTIAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-484-4285
Mailing Address - Street 1:15 TRUMAN ST
Mailing Address - Street 2:#207
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1161
Mailing Address - Country:US
Mailing Address - Phone:586-484-4285
Mailing Address - Fax:
Practice Address - Street 1:15 TRUMAN ST
Practice Address - Street 2:#207
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1161
Practice Address - Country:US
Practice Address - Phone:586-484-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092671101Y00000X, 1041C0700X, 106H00000X
MI6801100346101Y00000X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty