Provider Demographics
NPI:1821549627
Name:HEALING & GROWTH COUNSELING SERVICES
Entity Type:Organization
Organization Name:HEALING & GROWTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-861-5084
Mailing Address - Street 1:107 WATER ST
Mailing Address - Street 2:#206
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3451
Mailing Address - Country:US
Mailing Address - Phone:269-861-5084
Mailing Address - Fax:
Practice Address - Street 1:107 WATER ST
Practice Address - Street 2:#206
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3451
Practice Address - Country:US
Practice Address - Phone:269-861-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077510251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639385263OtherNPI