Provider Demographics
NPI:1801408893
Name:STILL SPACE COUNSELING LLC
Entity Type:Organization
Organization Name:STILL SPACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:231-487-2215
Mailing Address - Street 1:2202 MITCHELL PARK DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8897
Mailing Address - Country:US
Mailing Address - Phone:231-487-2215
Mailing Address - Fax:
Practice Address - Street 1:2202 MITCHELL PARK DR STE 2B
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8897
Practice Address - Country:US
Practice Address - Phone:231-487-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty