Provider Demographics
NPI:1790484962
Name:EMBODIED BREATH COUNSELING
Entity Type:Organization
Organization Name:EMBODIED BREATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWACZOK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-904-1449
Mailing Address - Street 1:888 PEACH BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3347
Mailing Address - Country:US
Mailing Address - Phone:586-904-1449
Mailing Address - Fax:
Practice Address - Street 1:210 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1976
Practice Address - Country:US
Practice Address - Phone:248-266-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center