Provider Demographics
NPI:1659110740
Name:OPEN DOOR COUNSELING SERVICES
Entity type:Organization
Organization Name:OPEN DOOR COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:KARON
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-456-5756
Mailing Address - Street 1:1268 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:429 YORKSHIRE BLVD APT 112
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3543
Practice Address - Country:US
Practice Address - Phone:313-288-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical