Provider Demographics
NPI:1891961116
Name:EASTSIDE COUNSELING AND CONSULTING, INC.
Entity Type:Organization
Organization Name:EASTSIDE COUNSELING AND CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:FIELDER
Authorized Official - Last Name:VORHEES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-516-3998
Mailing Address - Street 1:209 MERRIWEATHER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3533
Mailing Address - Country:US
Mailing Address - Phone:313-516-3998
Mailing Address - Fax:
Practice Address - Street 1:209 MERRIWEATHER RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3533
Practice Address - Country:US
Practice Address - Phone:313-516-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010157691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892961OtherBCBSM
MION18180Medicare PIN