Provider Demographics
NPI:1083059067
Name:DEDVUKAJ, CHRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DEDVUKAJ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26158 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4134
Mailing Address - Country:US
Mailing Address - Phone:248-860-5164
Mailing Address - Fax:
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 203
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3279
Practice Address - Country:US
Practice Address - Phone:248-381-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012065101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor