Provider Demographics
NPI:1164666475
Name:WHOLISTIC CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:WHOLISTIC CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANQUELLA
Authorized Official - Middle Name:EUNISE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLPC
Authorized Official - Phone:313-293-8603
Mailing Address - Street 1:17336 W 12 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2113
Mailing Address - Country:US
Mailing Address - Phone:313-293-8603
Mailing Address - Fax:
Practice Address - Street 1:17336 W 12 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2113
Practice Address - Country:US
Practice Address - Phone:313-293-8603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty