Provider Demographics
NPI:1619776887
Name:MOXIE COUNSELING CENTER OF MICHIGAN PLCC
Entity type:Organization
Organization Name:MOXIE COUNSELING CENTER OF MICHIGAN PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEEKHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-539-1216
Mailing Address - Street 1:2417 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3721
Mailing Address - Country:US
Mailing Address - Phone:248-705-2885
Mailing Address - Fax:
Practice Address - Street 1:2417 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3721
Practice Address - Country:US
Practice Address - Phone:248-705-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty