Healthcare Provider Details

I. General information

NPI: 1124132899
Provider Name (Legal Business Name): VOYAGE COUNSELING CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38345 W 10 MILE RD SUITE 150
FARMINGTON HILLS MI
48335-2867
US

IV. Provider business mailing address

38345 W 10 MILE RD SUITE 150
FARMINGTON HILLS MI
48335-2867
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-0422
  • Fax: 248-478-0435
Mailing address:
  • Phone: 248-478-0422
  • Fax: 248-478-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY A COSTINEW
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: PHD
Phone: 248-478-0422