Healthcare Provider Details

I. General information

NPI: 1013210087
Provider Name (Legal Business Name): ROBERTA M WOLSCHON LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 DIXIE HWY
IRA MI
48023-2813
US

IV. Provider business mailing address

9844 DIXIE HWY
FAIR HAVEN MI
48023
US

V. Phone/Fax

Practice location:
  • Phone: 586-716-7600
  • Fax: 586-716-7659
Mailing address:
  • Phone: 586-716-7600
  • Fax: 586-716-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401011066
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: