Provider Demographics
NPI:1710644786
Name:CONVERGENCE COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:CONVERGENCE COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-565-0830
Mailing Address - Street 1:46850 TILCH RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4725
Mailing Address - Country:US
Mailing Address - Phone:586-565-0830
Mailing Address - Fax:
Practice Address - Street 1:36401 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2957
Practice Address - Country:US
Practice Address - Phone:586-649-7589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty