Healthcare Provider Details

I. General information

NPI: 1437597101
Provider Name (Legal Business Name): DANA M AGRUSA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16651 21 MILE RD
MACOMB MI
48044-2603
US

IV. Provider business mailing address

47205 FREEDOM VALLEY DR
MACOMB MI
48044-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-520-2657
  • Fax:
Mailing address:
  • Phone: 248-520-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: