Organization
ORCHID CORE VOC REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA LYNETTE WHITE MA, LPC, CRC, CBIS (OWNER/LICENSED PROFESSIONAL COUNSEL)
(313) 588-6671
Entity
Organization
Contact information
Practice address
16250 NORTHLAND DR STE 325, SOUTHFIELD, MI 48075-5219
(248) 841-0448
Mailing address
PO BOX 27716, DETROIT, MI 48227-0716
(313) 588-6671
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
225C00000X
Rehabilitation Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194250837
—
MI
Enumeration date
07/20/2020
Last updated
07/20/2020
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