Provider Demographics
NPI:1942657689
Name:AMAZING GRACE COUNSELING OUTREACH
Entity Type:Organization
Organization Name:AMAZING GRACE COUNSELING OUTREACH
Other - Org Name:AGCO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ORAPIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUANROMANEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-417-9268
Mailing Address - Street 1:3160 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9207
Mailing Address - Country:US
Mailing Address - Phone:734-417-9268
Mailing Address - Fax:
Practice Address - Street 1:2035 HOGBACK RD # 204
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9732
Practice Address - Country:US
Practice Address - Phone:734-417-9268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health