Provider Demographics
NPI:1801345814
Name:BEAUTY FOR ASHES CRISIS AND COUNSELING SERVICE
Entity type:Organization
Organization Name:BEAUTY FOR ASHES CRISIS AND COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRICE
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:WHITE-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-687-7506
Mailing Address - Street 1:14383 FENTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3302
Mailing Address - Country:US
Mailing Address - Phone:313-687-7506
Mailing Address - Fax:
Practice Address - Street 1:14383 FENTON
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3302
Practice Address - Country:US
Practice Address - Phone:313-687-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X, 302R00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance Organization