Provider Demographics
NPI:1588920409
Name:FAMILY CHOICE COUNSELING & CASE MANAGEMENT SERVICES
Entity type:Organization
Organization Name:FAMILY CHOICE COUNSELING & CASE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAJUAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-210-7558
Mailing Address - Street 1:3280 N ELMS RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1871
Mailing Address - Country:US
Mailing Address - Phone:810-210-7558
Mailing Address - Fax:
Practice Address - Street 1:3280 N ELMS RD
Practice Address - Street 2:SUITE G
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1871
Practice Address - Country:US
Practice Address - Phone:810-210-7558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010889261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty