Provider Demographics
NPI:1811482664
Name:FAMILY, COUPLES & ADOLESCENCE COUNSELING, LLC
Entity type:Organization
Organization Name:FAMILY, COUPLES & ADOLESCENCE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC,QMHP, ICADC
Authorized Official - Phone:313-671-4002
Mailing Address - Street 1:3481 CASTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1749
Mailing Address - Country:US
Mailing Address - Phone:313-671-4002
Mailing Address - Fax:248-732-7500
Practice Address - Street 1:3525 ELIZABETH LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3087
Practice Address - Country:US
Practice Address - Phone:313-671-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty