Healthcare Provider Details

I. General information

NPI: 1376564591
Provider Name (Legal Business Name): LUCINDA ORWOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6022 W MAPLE RD STE 408
WEST BLOOMFIELD MI
48322-4408
US

IV. Provider business mailing address

1596 KIRTLAND DR
ANN ARBOR MI
48103-5724
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-3024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: