Provider Demographics
NPI:1063838902
Name:ICARE COUNSELING OF MICHIGAN, PLLC
Entity type:Organization
Organization Name:ICARE COUNSELING OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-292-3397
Mailing Address - Street 1:16950 19 MILE RD
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4804
Mailing Address - Country:US
Mailing Address - Phone:586-292-3397
Mailing Address - Fax:586-228-8809
Practice Address - Street 1:16950 19 MILE RD
Practice Address - Street 2:SUITE 3G
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4804
Practice Address - Country:US
Practice Address - Phone:586-292-3397
Practice Address - Fax:586-228-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085880261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health