Healthcare Provider Details

I. General information

NPI: 1861357212
Provider Name (Legal Business Name): A PLACE OF MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66077 W 8 MILE RD
SOUTH LYON MI
48178-7074
US

IV. Provider business mailing address

66077 W 8 MILE RD
SOUTH LYON MI
48178-7074
US

V. Phone/Fax

Practice location:
  • Phone: 989-906-1006
  • Fax:
Mailing address:
  • Phone: 989-906-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADRIANNA M PENA-VAN DEN BOSSCHE
Title or Position: CO-OWNER
Credential: M.S., LLPC
Phone: 248-264-2522