Healthcare Provider Details

I. General information

NPI: 1285907899
Provider Name (Legal Business Name): PROFESSIONAL ASSOCIATES IN REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE WAY STE. 104
LANSING MI
48911-4275
US

IV. Provider business mailing address

2929 COVINGTON CT STE. 201
LANSING MI
48912-4941
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-9801
  • Fax: 517-887-9826
Mailing address:
  • Phone: 517-371-4971
  • Fax: 517-371-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number330225
License Number StateMI

VIII. Authorized Official

Name: ROBERT J FABIANO
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 517-887-9801