Provider Demographics
NPI:1972069771
Name:PEARL STREET COUNSELING LLC
Entity Type:Organization
Organization Name:PEARL STREET COUNSELING LLC
Other - Org Name:HOLD YOUR OWN LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-668-4097
Mailing Address - Street 1:40 PEARL ST NW STE 341
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3028
Mailing Address - Country:US
Mailing Address - Phone:847-668-4097
Mailing Address - Fax:
Practice Address - Street 1:40 PEARL ST NW STE 341
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3028
Practice Address - Country:US
Practice Address - Phone:847-668-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty