Healthcare Provider Details

I. General information

NPI: 1437079746
Provider Name (Legal Business Name): LAVENDER COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WILWOOD RD
ROCHESTER HILLS MI
48309-2427
US

IV. Provider business mailing address

626 WILWOOD RD
ROCHESTER HILLS MI
48309-2427
US

V. Phone/Fax

Practice location:
  • Phone: 734-259-4578
  • Fax:
Mailing address:
  • Phone: 734-259-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA FERNANDA BERGANZA
Title or Position: THERAPIST
Credential: LLC
Phone: 734-259-4578