Healthcare Provider Details

I. General information

NPI: 1811472129
Provider Name (Legal Business Name): NOVELLA COUNSELING CENTER P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28777 NORTHWESTERN HWY STE 201
SOUTHFIELD MI
48034-8302
US

IV. Provider business mailing address

28777 NORTHWESTERN HWY STE 201
SOUTHFIELD MI
48034-8302
US

V. Phone/Fax

Practice location:
  • Phone: 313-231-6627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMEELA HEPBURN
Title or Position: C.E.O
Credential:
Phone: 313-231-6627