Provider Demographics
NPI:1629772397
Name:INNOVATIVE COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:INNOVATIVE COUNSELING SERVICES, PLLC
Other - Org Name:INNO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC J
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-877-6003
Mailing Address - Street 1:35429 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4258
Mailing Address - Country:US
Mailing Address - Phone:586-909-5031
Mailing Address - Fax:248-877-6003
Practice Address - Street 1:35429 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4258
Practice Address - Country:US
Practice Address - Phone:586-909-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)