Provider Demographics
NPI:1447537618
Name:COLLABORATIVE COUNSELING AND CONSULTATION SERVICES, LLC
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING AND CONSULTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NAKPANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-415-1686
Mailing Address - Street 1:32969 HAMILTON CT
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32969 HAMILTON CT
Practice Address - Street 2:SUITE 125
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3351
Practice Address - Country:US
Practice Address - Phone:313-415-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health