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General NPI Number Information
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NPI Number | 1639558620
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Entity Type | Organization
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Legal Business Name | ALLIANCE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1135 W UNIVERSITY DR STE 445
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City | ROCHESTER
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State | MI
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Zip | 48307-1871
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Country | US
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Telephone | 224-595-8416
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Fax |
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Provider Business Mailing Address
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Address Line | 2175 LONDON BRIDGE DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4234
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Country | US
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Telephone | 248-678-8606
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONINO AGOSTA
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Credential | PSYD
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Telephone | 248-678-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015487
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License Number State | MI
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