Healthcare Provider Details

I. General information

NPI: 1164030136
Provider Name (Legal Business Name): AMINA MCCLENDON LPC, CAADC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMINA GAMBLE

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E BIG BEAVER RD STE 200
TROY MI
48083-1434
US

IV. Provider business mailing address

625 E BIG BEAVER RD STE 200
TROY MI
48083-1434
US

V. Phone/Fax

Practice location:
  • Phone: 586-863-4000
  • Fax: 586-863-4004
Mailing address:
  • Phone: 586-863-4000
  • Fax: 586-863-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401223701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: