Provider Demographics
NPI:1669345120
Name:INNERVISION COUNSELING & CONSULTATION SERVICE, LLC
Entity type:Organization
Organization Name:INNERVISION COUNSELING & CONSULTATION SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DJUANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMPTON-RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-525-0883
Mailing Address - Street 1:29350 MARIMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1615
Mailing Address - Country:US
Mailing Address - Phone:248-525-0883
Mailing Address - Fax:
Practice Address - Street 1:29350 MARIMOOR DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1615
Practice Address - Country:US
Practice Address - Phone:248-525-0883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty