Healthcare Provider Details

I. General information

NPI: 1962705277
Provider Name (Legal Business Name): NOORAYNE E CHEVALIER MA, LLP, CACII, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOORAYNE NORENE E. CHEVALIER MA, LLP, CACII, CGC

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19445 W WARREN AVE
DETROIT MI
48228-3361
US

IV. Provider business mailing address

19445 W WARREN AVE
DETROIT MI
48228-3361
US

V. Phone/Fax

Practice location:
  • Phone: 313-307-0088
  • Fax: 313-281-2235
Mailing address:
  • Phone: 313-307-0088
  • Fax: 313-281-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301011017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: