Provider Demographics
NPI:1659901783
Name:DETROIT COUNSELING AND WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:DETROIT COUNSELING AND WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-MINGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C
Authorized Official - Phone:313-985-0243
Mailing Address - Street 1:PO BOX 21063
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-0063
Mailing Address - Country:US
Mailing Address - Phone:313-985-0243
Mailing Address - Fax:313-985-0243
Practice Address - Street 1:17250 W 12 MILE RD STE 213
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2123
Practice Address - Country:US
Practice Address - Phone:313-985-0243
Practice Address - Fax:313-985-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508322322Medicaid