Provider Demographics
NPI:1265219810
Name:HEALING PLACE LIFE COACH AND COUNSELING CENTER
Entity type:Organization
Organization Name:HEALING PLACE LIFE COACH AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LPC
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-896-4547
Mailing Address - Street 1:7277 ARBOR TRL APT 107
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4515
Mailing Address - Country:US
Mailing Address - Phone:248-896-4547
Mailing Address - Fax:
Practice Address - Street 1:7277 ARBOR TRL APT 107
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4515
Practice Address - Country:US
Practice Address - Phone:248-896-4547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty