Healthcare Provider Details

I. General information

NPI: 1801305222
Provider Name (Legal Business Name): JUANITA BOBO LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

IV. Provider business mailing address

119 SW MAYNARD RD STE 200
CARY NC
27511-4472
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax: 313-565-0309
Mailing address:
  • Phone: 919-822-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: