1477736064 NPI number — EKONG COUNSELING CENTER

Table of content: (NPI 1477736064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477736064 NPI number — EKONG COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EKONG COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477736064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29532 SOUTHFIELD RD
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-469-8322
Provider Business Mailing Address Fax Number:
248-423-4249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29532 SOUTHFIELD RD
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-469-8322
Provider Business Practice Location Address Fax Number:
248-423-4249
Provider Enumeration Date:
12/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EKONG
Authorized Official First Name:
LAVINIA
Authorized Official Middle Name:
RUCKES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-469-8322

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  6301015337 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0898217 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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