Provider Demographics
NPI: | 1710250949 |
---|---|
Name: | TRINITY COUNSELING GROUP |
Entity Type: | Organization |
Organization Name: | TRINITY COUNSELING GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEWART |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 269-760-6797 |
Mailing Address - Street 1: | 4566 WISHING WELL CT |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTAGE |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49024-4655 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 269-760-6797 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4566 WISHING WELL CT |
Practice Address - Street 2: | |
Practice Address - City: | PORTAGE |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49024-4655 |
Practice Address - Country: | US |
Practice Address - Phone: | 269-760-6797 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-19 |
Last Update Date: | 2012-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6401009011 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |