Provider Demographics
NPI:1669823894
Name:RADIANT COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:RADIANT COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:586-354-3127
Mailing Address - Street 1:15869 SPUR DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2214
Mailing Address - Country:US
Mailing Address - Phone:586-354-3127
Mailing Address - Fax:
Practice Address - Street 1:15869 SPUR DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2214
Practice Address - Country:US
Practice Address - Phone:586-354-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013058251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health