Individual
COLLEEN MARIE TAVOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC, CCTP
Contact information
Practice address
17344 W 12 MILE RD, SUITE 203, SOUTHFIELD, MI 48076-2121
(248) 302-9396
Mailing address
32718 GRAND RIVER AVE UNIT C5, FARMINGTON, MI 48336-3155
(248) 302-9396
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401010162
MI
101YM0800X
Mental Health Counselor
Primary
6401010162
MI
101YP2500X
Professional Counselor
6401010162
MI
Other
Enumeration date
05/12/2014
Last updated
01/04/2016
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