Healthcare Provider Details

I. General information

NPI: 1861919078
Provider Name (Legal Business Name): G. COLOMBINI COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N OLD WOODWARD AVE STE 303
BIRMINGHAM MI
48009-3862
US

IV. Provider business mailing address

630 N OLD WOODWARD AVE STE 303
BIRMINGHAM MI
48009-3862
US

V. Phone/Fax

Practice location:
  • Phone: 248-259-6290
  • Fax: 248-282-7013
Mailing address:
  • Phone: 248-259-6290
  • Fax: 248-282-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801084080
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GIGI COLOMBINI
Title or Position: OWNER
Credential: LMSW
Phone: 248-259-6290