Individual
ANDRA MODOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLPC, NCE
Contact information
Practice address
7415 HARRISON ST, WESTLAND, MI 48185-2629
(734) 578-6019
Mailing address
7415 HARRISON ST, WESTLAND, MI 48185-2629
(734) 578-6019
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPCC.0018266
CO
Other
Enumeration date
04/15/2021
Last updated
04/15/2021
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