Healthcare Provider Details

I. General information

NPI: 1255759486
Provider Name (Legal Business Name): LAKE ORION COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 CLARKSTON RD
CLARKSTON MI
48348-5215
US

IV. Provider business mailing address

3604 CLARKSTON RD
CLARKSTON MI
48348-5215
US

V. Phone/Fax

Practice location:
  • Phone: 248-595-9969
  • Fax: 248-814-0361
Mailing address:
  • Phone: 248-595-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015095
License Number StateMI

VIII. Authorized Official

Name: DR. ADAM ROSS PASCIAK
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD, LP
Phone: 248-807-9894