Provider Demographics
NPI:1063281418
Name:ENDLESS POSSIBILITIES COUNSELING CLINIC
Entity type:Organization
Organization Name:ENDLESS POSSIBILITIES COUNSELING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-980-1254
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-0132
Mailing Address - Country:US
Mailing Address - Phone:313-980-1254
Mailing Address - Fax:
Practice Address - Street 1:22430 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-7048
Practice Address - Country:US
Practice Address - Phone:313-980-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health