Organization
12TH AVENUE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIGAIL LEIGH BLACKSHIRE LPC (CHIEF EXECUTIVE OFFICER)
(248) 795-5253
Entity
Organization
Contact information
Practice address
5541 WARBLER DR, CLARKSTON, MI 48346-2965
(248) 795-5253
(248) 928-5350
Mailing address
5541 WARBLER DR, CLARKSTON, MI 48346-2965
(248) 795-5253
(248) 928-5350
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285110288
—
AK
Enumeration date
01/17/2024
Last updated
01/17/2024
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