Healthcare Provider Details

I. General information

NPI: 1649944851
Provider Name (Legal Business Name): BALANCED MIND COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31225 PORTSIDE DR APT 12203
NOVI MI
48377-4253
US

IV. Provider business mailing address

31225 PORTSIDE DR APT 12203
NOVI MI
48377-4253
US

V. Phone/Fax

Practice location:
  • Phone: 734-673-5205
  • Fax:
Mailing address:
  • Phone: 734-673-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NADIA COROIU
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 734-673-5205