Healthcare Provider Details

I. General information

NPI: 1356100986
Provider Name (Legal Business Name): YAOCHONG HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2167 COMMONS PKWY
OKEMOS MI
48864-3987
US

IV. Provider business mailing address

3820 LONE PINE DR APT 4
HOLT MI
48842-8801
US

V. Phone/Fax

Practice location:
  • Phone: 517-896-3592
  • Fax:
Mailing address:
  • Phone: 360-672-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: