Provider Demographics
NPI:1194049643
Name:AFTERGLOW COUNSELING, MEDIATION, AND FAMILY SERVICES CENTERS
Entity type:Organization
Organization Name:AFTERGLOW COUNSELING, MEDIATION, AND FAMILY SERVICES CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/FOUNDER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA-JOYCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARKERT-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT, LMFT
Authorized Official - Phone:909-503-7191
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-0024
Mailing Address - Country:US
Mailing Address - Phone:909-503-7191
Mailing Address - Fax:
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:#24
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1372
Practice Address - Country:US
Practice Address - Phone:909-503-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48104101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X, 103G00000X, 103K00000X, 106H00000X
CA25894104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty