Organization
CORE COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIERRA YOUNGBLOOD-FIELD LPC, LLMFT (PROFESSIONAL COUNSELOR)
(616) 420-1060
Entity
Organization
Contact information
Practice address
1345 MONROE AVE NW STE 234, GRAND RAPIDS, MI 49505-4692
(616) 420-1060
Mailing address
1345 MONROE AVE NW STE 234, GRAND RAPIDS, MI 49505-4692
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205320561
—
MI
Enumeration date
06/20/2018
Last updated
12/31/2019
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