Provider Demographics
NPI:1366753477
Name:EL SHADDAI COUNSELING & CONSULTATION SERVICES
Entity type:Organization
Organization Name:EL SHADDAI COUNSELING & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:734-240-0372
Mailing Address - Street 1:105 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2477
Mailing Address - Country:US
Mailing Address - Phone:734-240-0372
Mailing Address - Fax:888-277-5583
Practice Address - Street 1:105 E FRONT ST STE 204
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2160
Practice Address - Country:US
Practice Address - Phone:734-240-0372
Practice Address - Fax:888-277-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091061101Y00000X
OHC.0600123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty