Healthcare Provider Details

I. General information

NPI: 1508302142
Provider Name (Legal Business Name): XINYI FANG LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 E MOUNT HOPE AVE STE 2
LANSING MI
48910-1931
US

IV. Provider business mailing address

2517 E MOUNT HOPE AVE STE 2
LANSING MI
48910-1931
US

V. Phone/Fax

Practice location:
  • Phone: 517-245-0725
  • Fax:
Mailing address:
  • Phone: 517-245-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: