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Organization
PROFOUND PSYCHOTHERAPY LLC
Active
Organization
PROFOUND PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AZELDRI VAN DER WATH LCSW (THERAPIST)
(248) 250-2530
Entity
Organization
Contact information
Practice address
145 S LIVERNOIS RD # 113, ROCHESTER HILLS, MI 48307-1837
(248) 250-0253
Mailing address
41423 AMBERCREST DR, STERLING HEIGHTS, MI 48314-3719
(248) 250-0253
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/12/2020
Last updated
01/28/2021
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