| A Safe Place Counselling And Community Support Services L3c | |
|
20216 Albany St Detroit MI 48234-2505 | |
| (313) 384-4783 | |
| Not Available |
| Full Name | A Safe Place Counselling And Community Support Services L3c |
|---|---|
| Speciality | Counselor |
| Location | 20216 Albany St, Detroit, Michigan |
| Authorized Official Name and Position | Tina Diane Ealey (PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 3133844783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Safe Place Counselling And Community Support Services L3c 20222 Albany St Detroit MI 48234-2505 Ph: () - | A Safe Place Counselling And Community Support Services L3c 20216 Albany St Detroit MI 48234-2505 Ph: (313) 384-4783 |
| NPI Number | 1487280848 |
|---|---|
| Provider Enumeration Date | 03/18/2020 |
| Last Update Date | 01/03/2025 |
| Certification Date | 01/03/2025 |
| Medicare PECOS PAC ID | 5193255917 |
|---|---|
| Medicare Enrollment ID | O20250210001481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487280848 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tina Diane Ealey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649831280 PECOS PAC ID: 6002346822 Enrollment ID: I20250210001560 |
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