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General NPI Number Information
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NPI Number | 1285907899
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ASSOCIATES IN REHABILITATION LLC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 3960 PATIENT CARE WAY STE. 104
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City | LANSING
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State | MI
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Zip | 48911-4275
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Country | US
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Telephone | 517-887-9801
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Fax | 517-887-9826
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Provider Business Mailing Address
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Address Line | 2929 COVINGTON CT STE. 201
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City | LANSING
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State | MI
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Zip | 48912-4941
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Country | US
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Telephone | 517-371-4971
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Fax | 517-371-4475
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT J FABIANO
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Credential | PHD
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Telephone | 517-887-9801
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 330225
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License Number State | MI
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