Healthcare Provider Details

I. General information

NPI: 1811253933
Provider Name (Legal Business Name): JASON ANDREW GIANNINI L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 CLARKSTON RD # 102
CLARKSTON MI
48348-5215
US

IV. Provider business mailing address

344 WORDSWORTH ST
FERNDALE MI
48220-2580
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 248-892-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007454
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401007454
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: