Provider Demographics
NPI:1689078610
Name:PROPHETIC SOLUTIONS PROFESSIONAL COUNSELING, PLLC
Entity Type:Organization
Organization Name:PROPHETIC SOLUTIONS PROFESSIONAL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-506-3322
Mailing Address - Street 1:25245 5 MILE RD
Mailing Address - Street 2:STE 700
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3701
Mailing Address - Country:US
Mailing Address - Phone:313-506-3322
Mailing Address - Fax:
Practice Address - Street 1:25245 5 MILE RD STE 600
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3785
Practice Address - Country:US
Practice Address - Phone:313-506-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085243251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health