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General NPI Number Information
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NPI Number | 1689887531
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Entity Type | Individual
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Provider Name | ELVITA KONDILI LPC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 1 PARKLANE BLVD STE 1210
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City | DEARBORN
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State | MI
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Zip | 48126-2400
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Country | US
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Telephone | 704-208-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 250 E HARBORTOWN DR APT 708
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City | DETROIT
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State | MI
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Zip | 48207-5011
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Country | US
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Telephone | 704-776-0327
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401017573
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License Number State | MI
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