Organization
COMBINED SUCCESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IDA VERONICA COLQUITT MA, LLP (THERAPIST)
(248) 763-0801
Entity
Organization
Contact information
Practice address
18620 W 10 MILE RD, SOUTHFIELD, MI 48075-2667
(248) 763-0801
Mailing address
20690 WAYLAND ST, SOUTHFIELD, MI 48076-5666
(248) 763-0801
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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