Provider Demographics
NPI:1710452271
Name:DOWNRIVER PROFESSIONAL COUNSELING, PLLC
Entity Type:Organization
Organization Name:DOWNRIVER PROFESSIONAL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:248-760-3125
Mailing Address - Street 1:7000 ROOSEVELT AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2583
Mailing Address - Country:US
Mailing Address - Phone:248-760-3125
Mailing Address - Fax:
Practice Address - Street 1:7000 ROOSEVELT AVE STE 203
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2583
Practice Address - Country:US
Practice Address - Phone:248-760-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty