Provider Demographics
NPI:1861250490
Name:UNWAVERING SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:UNWAVERING SUPPORT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIZELL
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, CCTP, ASDI
Authorized Official - Phone:734-237-7199
Mailing Address - Street 1:3763 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1339
Mailing Address - Country:US
Mailing Address - Phone:734-237-7199
Mailing Address - Fax:
Practice Address - Street 1:3763 17TH ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1339
Practice Address - Country:US
Practice Address - Phone:734-237-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty