Basic Information
Provider Information
NPI: 1649941287
EntityType: 2
ReplacementNPI:  
OrganizationName: POSITIVE HEALING COUNSELING
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20290 DRUMMOND BAY
Address2:  
City: CLINTON TWP
State: MI
PostalCode: 480381467
CountryCode: US
TelephoneNumber: 5862010736
FaxNumber:  
Practice Location
Address1: 20290 DRUMMOND BAY
Address2:  
City: CLINTON TWP
State: MI
PostalCode: 480381467
CountryCode: US
TelephoneNumber: 5862010736
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/23/2021
LastUpdateDate: 09/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LUECK
AuthorizedOfficialFirstName: IZABELA
AuthorizedOfficialMiddleName: MALGORZATA
AuthorizedOfficialTitleorPosition: CLINICAL THERAPIST
AuthorizedOfficialTelephone: 5862010736
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LPC
NPICertificationDate: 09/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0850X  Y Ambulatory Health Care FacilitiesClinic/CenterAdult Mental Health

No ID Information.


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