Healthcare Provider Details

I. General information

NPI: 1750883872
Provider Name (Legal Business Name): LAUREN JUSTINE ENFROY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN JUSTINE YOUNG LPC

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E MAIN ST
NORTHVILLE MI
48167-7400
US

IV. Provider business mailing address

33849 ANGELINE AVE
LIVONIA MI
48150-2695
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-5845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1700511
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: