Healthcare Provider Details

I. General information

NPI: 1073454260
Provider Name (Legal Business Name): NOVA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30100 TELEGRAPH RD STE 341
BINGHAM FARMS MI
48025-5804
US

IV. Provider business mailing address

3299 BUCKINGHAM AVE
BERKLEY MI
48072-1319
US

V. Phone/Fax

Practice location:
  • Phone: 248-229-9385
  • Fax:
Mailing address:
  • Phone: 248-229-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA POLK
Title or Position: LMSW
Credential:
Phone: 248-229-9385