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General NPI Number Information
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NPI Number | 1639707714
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Entity Type | Organization
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Legal Business Name | ALLAY COUNSELING PLLC
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 143 W SAINT CLAIR ST
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City | ROMEO
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State | MI
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Zip | 48065-4657
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Country | US
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Telephone | 248-410-1559
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Fax |
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Provider Business Mailing Address
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Address Line | 66773 CAMPGROUND RD
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City | WASHINGTON TOWNSHIP
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State | MI
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Zip | 48095-1854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MR. ANDREW TAROCKOFF
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Credential |
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Telephone | 248-410-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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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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