=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033485370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRA MICHELLE THORINGTON-FOX LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2012
-----------------------------------------------------
Last Update Date | 12/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24500 FORD RD STE 3
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-629-9169
-----------------------------------------------------
Fax | 248-250-5392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14200 W 8 MILE RD UNIT 47526
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48237-7765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-629-9169
-----------------------------------------------------
Fax | 248-250-5392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401011827
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------