Provider Demographics
NPI:1942388350
Name:COUNSELING CONNECTION
Entity Type:Organization
Organization Name:COUNSELING CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS-EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-356-8399
Mailing Address - Street 1:18865 BRETTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223
Mailing Address - Country:US
Mailing Address - Phone:248-356-8399
Mailing Address - Fax:248-353-2786
Practice Address - Street 1:29777 TELEGRAPH RD
Practice Address - Street 2:ONYX PLAZA
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-356-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801018777101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty