Healthcare Provider Details

I. General information

NPI: 1376371021
Provider Name (Legal Business Name): ART AND MIND CREATIVE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19945 OHIO ST
DETROIT MI
48221-1116
US

IV. Provider business mailing address

19945 OHIO ST
DETROIT MI
48221-1116
US

V. Phone/Fax

Practice location:
  • Phone: 231-670-4160
  • Fax:
Mailing address:
  • Phone: 231-670-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RACHEL E BORDUIN
Title or Position: SOLE MEMBER/AUTHORIZED OFFICIAL
Credential: LPC
Phone: 231-670-4160