Provider Demographics
NPI:1093034548
Name:AKINS, CONNIE LORRAINE (MA)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LORRAINE
Last Name:AKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LORRAINE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA , LPC, CAAC
Mailing Address - Street 1:7330 DEEP RUN
Mailing Address - Street 2:1523
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3827
Mailing Address - Country:US
Mailing Address - Phone:734-347-8684
Mailing Address - Fax:
Practice Address - Street 1:7330 DEEP RUN
Practice Address - Street 2:1523
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3827
Practice Address - Country:US
Practice Address - Phone:734-347-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-01837101YA0400X
MI6401001985101YP2500X
MISC0000595101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool