Provider Demographics
NPI:1063393692
Name:IMPACT COUNSELING PARTNERS OF MICHIGAN, LLC
Entity type:Organization
Organization Name:IMPACT COUNSELING PARTNERS OF MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-470-7004
Mailing Address - Street 1:38086 LANTERN HILL CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2896
Mailing Address - Country:US
Mailing Address - Phone:248-470-7004
Mailing Address - Fax:
Practice Address - Street 1:32231 SCHOOLCRAFT RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4312
Practice Address - Country:US
Practice Address - Phone:734-266-6800
Practice Address - Fax:734-266-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty