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General NPI Number Information
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NPI Number | 1093129322
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Entity Type | Individual
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Provider Name | JANNISE NEWBY LLPC
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Gender | Female
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Dates
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Enumeration Date | 06/14/2014
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 2000 TOWN CTR 1900
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1135
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Country | US
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Telephone | 248-733-5142
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Fax |
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Provider Business Mailing Address
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Address Line | 22750 WOODWARD AVE STE 208
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City | FERNDALE
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State | MI
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Zip | 48220-1753
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Country | US
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Telephone | 248-733-5142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401013995
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License Number State | MI
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