Provider Demographics
NPI:1629734702
Name:ROCKPORT COUNSELING LLC
Entity Type:Organization
Organization Name:ROCKPORT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-412-2200
Mailing Address - Street 1:14805 DETROIT AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3920
Mailing Address - Country:US
Mailing Address - Phone:216-412-2200
Mailing Address - Fax:216-803-6723
Practice Address - Street 1:14805 DETROIT AVE STE 450
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3920
Practice Address - Country:US
Practice Address - Phone:216-412-2200
Practice Address - Fax:216-803-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty