Provider Demographics
NPI:1316717101
Name:GRASSROOTS COMMUNITY COUNSELING SERVICES
Entity type:Organization
Organization Name:GRASSROOTS COMMUNITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RESHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:517-220-5521
Mailing Address - Street 1:4528 BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-2962
Mailing Address - Country:US
Mailing Address - Phone:517-328-8210
Mailing Address - Fax:
Practice Address - Street 1:4528 BALLARD RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-2962
Practice Address - Country:US
Practice Address - Phone:517-220-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health