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General NPI Number Information
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NPI Number | 1467702407
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Entity Type | Individual
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Provider Name | MYA PATRICE NDIAYE
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Gender | Female
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 16320 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2440
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Country | US
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Telephone | 313-414-1945
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Fax | 586-944-2731
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Provider Business Mailing Address
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Address Line | 16320 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2440
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Country | US
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Telephone | 313-414-1945
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Fax | 586-944-2731
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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 | 6301015244
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 6301015244
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-25043
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License Number State | MI
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