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General NPI Number Information
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NPI Number | 1255088282
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Entity Type | Individual
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Provider Name | VIVIANNA RUBLES LLPC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 6770 DIXIE HWY STE 103
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City | CLARKSTON
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State | MI
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Zip | 48346-2088
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Country | US
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Telephone | 248-922-7726
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Fax | 248-856-1492
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Provider Business Mailing Address
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Address Line | 25387 WITHERSPOON ST
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-1367
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Country | US
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Telephone | 248-505-0910
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451021955
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License Number State | MI
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