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General NPI Number Information
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NPI Number | 1316555998
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Entity Type | Organization
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Legal Business Name | ORCHID CORE VOC REHAB LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR STE 325
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5219
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Country | US
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Telephone | 248-841-0448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27716
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City | DETROIT
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State | MI
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Zip | 48227-0716
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Country | US
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Telephone | 313-588-6671
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PROFESSIONAL COUNSEL
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Name | TAMARA LYNETTE WHITE
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Credential | MA, LPC, CRC, CBIS
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Telephone | 313-588-6671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation 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 | 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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