Provider Demographics
NPI:1134930795
Name:BLUE BRANCH ADVOCACY AND COUNSELING
Entity type:Organization
Organization Name:BLUE BRANCH ADVOCACY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACINTA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FLOREK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MPH
Authorized Official - Phone:248-225-7799
Mailing Address - Street 1:22036 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22036 CHASE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4770
Practice Address - Country:US
Practice Address - Phone:734-237-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty