Healthcare Provider Details

I. General information

NPI: 1326580432
Provider Name (Legal Business Name): ROCHESTER EVIDENCE-BASED PSYCHOTHERAPY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S MAIN ST SUITE 201
ROCHESTER MI
48307
US

IV. Provider business mailing address

414 S MAIN ST SUITE 201
ROCHESTER MI
48307-2068
US

V. Phone/Fax

Practice location:
  • Phone: 248-568-5180
  • Fax: 248-429-2132
Mailing address:
  • Phone: 248-568-5180
  • Fax: 248-429-2132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011306
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006671
License Number StateMI

VIII. Authorized Official

Name: MR. ADAM G. HAMILTON
Title or Position: OWNER
Credential: MA, LPC, LLMFT, NCC
Phone: 248-568-5180