Basic Information
| Provider Information | |||||||||
| NPI: | 1508472606 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CCS-MI | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | CONNECTIONS COUNSELING SERVICES PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W CORUNNA AVE | ||||||||
| Address2: | |||||||||
| City: | CORUNNA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488171378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102758122 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W CORUNNA AVE | ||||||||
| Address2: | |||||||||
| City: | CORUNNA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488171378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102758122 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2020 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AKERS | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, LMSW | ||||||||
| AuthorizedOfficialTelephone: | 9894941114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.