Healthcare Provider Details

I. General information

NPI: 1780192054
Provider Name (Legal Business Name): AFFINITY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E EISENHOWER PKWY STE 15
ANN ARBOR MI
48108-3321
US

IV. Provider business mailing address

455 E EISENHOWER PKWY STE 15
ANN ARBOR MI
48108-3321
US

V. Phone/Fax

Practice location:
  • Phone: 734-219-9260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TANG
Title or Position: PARTNER
Credential: PHD
Phone: 734-219-9260