Healthcare Provider Details

I. General information

NPI: 1972771533
Provider Name (Legal Business Name): TRINA COLETTE SKORUPA MSW, LMSW, PSYP, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD SUITE 310
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

29321 HERBERT ST
MADISON HEIGHTS MI
48071-2510
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-0636
  • Fax: 734-425-4771
Mailing address:
  • Phone: 248-635-9867
  • Fax: 734-425-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801060926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: