Provider Demographics
NPI:1427427814
Name:INTENTIONAL COUNSELING SERVICES
Entity type:Organization
Organization Name:INTENTIONAL COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-879-0162
Mailing Address - Street 1:2142A WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1708
Mailing Address - Country:US
Mailing Address - Phone:734-879-0162
Mailing Address - Fax:734-879-0167
Practice Address - Street 1:2142A WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1708
Practice Address - Country:US
Practice Address - Phone:734-879-0162
Practice Address - Fax:734-879-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty