Provider Demographics
NPI:1851344824
Name:NORTHWEST COUNSELING & PSYCHOTHERAPY CENTE
Entity Type:Organization
Organization Name:NORTHWEST COUNSELING & PSYCHOTHERAPY CENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-254-3332
Mailing Address - Street 1:30375 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3297
Mailing Address - Country:US
Mailing Address - Phone:248-254-3332
Mailing Address - Fax:248-254-3333
Practice Address - Street 1:30375 NORTHWESTERN HWY.
Practice Address - Street 2:SUITE #200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3297
Practice Address - Country:US
Practice Address - Phone:248-254-3332
Practice Address - Fax:248-254-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509107710OtherBCBS