Provider Demographics
NPI:1730466020
Name:QUIET HARBOR COUNSELING, PLC
Entity Type:Organization
Organization Name:QUIET HARBOR COUNSELING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LLP, LMSW, PSYD
Authorized Official - Phone:231-348-3452
Mailing Address - Street 1:319 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4269
Mailing Address - Country:US
Mailing Address - Phone:231-348-3452
Mailing Address - Fax:
Practice Address - Street 1:319 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4269
Practice Address - Country:US
Practice Address - Phone:231-348-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089066251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health