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General NPI Number Information
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NPI Number | 1164983193
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Entity Type | Organization
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Legal Business Name | INSIGHT COUNSELING CENTER OF TROY, LLC.
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 03/31/2019
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Provider Practice Location Address
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Address Line | 650 E. BIG BEAVER SUITE B
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City | TROY
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State | MI
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Zip | 48083-1432
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Country | US
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Telephone | 248-797-2148
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Fax |
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Provider Business Mailing Address
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Address Line | 650 E. BIG BEAVER SUITE B
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City | TROY
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State | MI
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Zip | 48083-1432
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Country | US
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Telephone | 248-797-2148
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | DONNA WIDMAN
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Credential | MA, LPC
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Telephone | 248-797-2148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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