Healthcare Provider Details

I. General information

NPI: 1831654326
Provider Name (Legal Business Name): INTROSPECTIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY STE 220
SOUTHFIELD MI
48075-2437
US

IV. Provider business mailing address

24445 NORTHWESTERN HWY STE 220
SOUTHFIELD MI
48075-2437
US

V. Phone/Fax

Practice location:
  • Phone: 248-242-5545
  • Fax:
Mailing address:
  • Phone: 313-207-5581
  • Fax: 248-450-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JARRETTE WRIGHT-BOOKER
Title or Position: OWNER
Credential: MA, LPC, CAADC
Phone: 313-207-5581