Provider Demographics
NPI:1912362419
Name:AVORTEX COUNSELING AND COACHING SERVICES
Entity Type:Organization
Organization Name:AVORTEX COUNSELING AND COACHING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-208-2430
Mailing Address - Street 1:641 MCDOUGALL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3980
Mailing Address - Country:US
Mailing Address - Phone:313-208-2430
Mailing Address - Fax:
Practice Address - Street 1:641 MCDOUGALL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3980
Practice Address - Country:US
Practice Address - Phone:313-208-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680408197251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health