Organization
PROVISIONAL THERAPY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINA MARI ESCAMILLA LMSW (GROUP REPRESENTATIVE)
(248) 240-2963
Entity
Organization
Contact information
Practice address
4241 BRECKENRIDGE DR, WEST BLOOMFIELD, MI 48322-4430
(248) 240-2963
Mailing address
4241 BRECKENRIDGE DR, WEST BLOOMFIELD, MI 48322-4430
(248) 240-2963
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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