Healthcare Provider Details

I. General information

NPI: 1962783662
Provider Name (Legal Business Name): KORI LYNN AGIUS LMSW CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 ORCHARD LAKE RD STE 202
WEST BLOOMFIELD MI
48322-4519
US

IV. Provider business mailing address

41800 W 11 MILE RD STE 110
NOVI MI
48375-1818
US

V. Phone/Fax

Practice location:
  • Phone: 877-693-5543
  • Fax: 248-221-1775
Mailing address:
  • Phone: 877-693-5543
  • Fax: 248-221-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801093272
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: