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General NPI Number Information
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NPI Number | 1952750895
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Entity Type | Organization
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Legal Business Name | BA NEW YOU COUNSELING AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 19111 W 10 MILE RD SUITE #224
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2417
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Country | US
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Telephone | 248-721-4608
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Fax |
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Provider Business Mailing Address
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Address Line | 19111 W 10 MILE RD SUITE #224
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2417
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Country | US
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Telephone | 248-721-4608
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ALEXANDRA J COLVARD
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Credential | MA, LPC, CAADC
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Telephone | 248-721-4608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401014155
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License Number State | MI
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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 | 6401009266
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License Number State | MI
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