Provider Demographics
NPI:1629069471
Name:COUNSELING ASSOCIATES INC
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES INC
Other - Org Name:COUNSELING ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:248-626-1500
Mailing Address - Street 1:6960 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4515
Mailing Address - Country:US
Mailing Address - Phone:248-626-1500
Mailing Address - Fax:248-626-1551
Practice Address - Street 1:6960 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4515
Practice Address - Country:US
Practice Address - Phone:248-626-1500
Practice Address - Fax:248-626-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P12140Medicare ID - Type UnspecifiedMSWS
MI0P12130Medicare ID - Type UnspecifiedPHDS
MI0P11960Medicare ID - Type UnspecifiedMDS