Provider Demographics
NPI:1356941280
Name:PEACEFUL PRIDE COUNSELING LLC
Entity type:Organization
Organization Name:PEACEFUL PRIDE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-341-4841
Mailing Address - Street 1:3916 NOTTINGHAM TER
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6217
Mailing Address - Country:US
Mailing Address - Phone:989-321-0391
Mailing Address - Fax:
Practice Address - Street 1:3916 NOTTINGHAM TER
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6217
Practice Address - Country:US
Practice Address - Phone:989-321-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health