Healthcare Provider Details

I. General information

NPI: 1902397763
Provider Name (Legal Business Name): TRANSITIONS OF ANN ARBOR COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 ASHLEY LN
WEST BLOOMFIELD MI
48324-4110
US

IV. Provider business mailing address

2859 ASHLEY LN
WEST BLOOMFIELD MI
48324-4110
US

V. Phone/Fax

Practice location:
  • Phone: 248-396-6271
  • Fax:
Mailing address:
  • Phone: 248-396-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080766
License Number StateMI

VIII. Authorized Official

Name: REBECCA DERAUD
Title or Position: OWNER
Credential:
Phone: 248-396-6271