Provider Demographics
NPI:1013567700
Name:JAYAWARDENA, NISHANI (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:NISHANI
Middle Name:
Last Name:JAYAWARDENA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HENDRIE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3734
Mailing Address - Country:US
Mailing Address - Phone:989-941-6821
Mailing Address - Fax:
Practice Address - Street 1:145 ROCHDALE DR S STE F
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2275
Practice Address - Country:US
Practice Address - Phone:248-608-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6401222279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health