Provider Demographics
NPI:1053621029
Name:COUNSELING SOLUTIONS, LLC
Entity type:Organization
Organization Name:COUNSELING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:TYLENDA-WONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, DCSW
Authorized Official - Phone:248-341-0710
Mailing Address - Street 1:1367 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6590
Mailing Address - Country:US
Mailing Address - Phone:248-341-0710
Mailing Address - Fax:248-212-0693
Practice Address - Street 1:415 S WEST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2521
Practice Address - Country:US
Practice Address - Phone:248-341-0710
Practice Address - Fax:248-212-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010824311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11905475OtherCAQH UNIVERSAL PROVIDER DATABASE
MI8008984430OtherBCBS