Healthcare Provider Details

I. General information

NPI: 1316555998
Provider Name (Legal Business Name): ORCHID CORE VOC REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NORTHLAND DR STE 325
SOUTHFIELD MI
48075-5219
US

IV. Provider business mailing address

PO BOX 27716
DETROIT MI
48227-0716
US

V. Phone/Fax

Practice location:
  • Phone: 248-841-0448
  • Fax:
Mailing address:
  • Phone: 313-588-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: TAMARA LYNETTE WHITE
Title or Position: OWNER/LICENSED PROFESSIONAL COUNSEL
Credential: MA, LPC, CRC, CBIS
Phone: 313-588-6671