Provider Demographics
NPI:1831790542
Name:PEACE MANIFESTED COUNSELING SERVICE, LLC
Entity type:Organization
Organization Name:PEACE MANIFESTED COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-909-6903
Mailing Address - Street 1:27533 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4931
Mailing Address - Country:US
Mailing Address - Phone:313-909-6903
Mailing Address - Fax:
Practice Address - Street 1:27533 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4931
Practice Address - Country:US
Practice Address - Phone:313-909-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty