Provider Demographics
NPI:1912775818
Name:INTEGRATIVE COUNSELING SERVICES OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING SERVICES OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:586-354-3127
Mailing Address - Street 1:15869 SPUR DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2214
Mailing Address - Country:US
Mailing Address - Phone:586-354-3127
Mailing Address - Fax:
Practice Address - Street 1:15869 SPUR DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2214
Practice Address - Country:US
Practice Address - Phone:586-354-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty