Provider Demographics
NPI:1093129322
Name:NEWBY, JANNISE (LLPC)
Entity Type:Individual
Prefix:
First Name:JANNISE
Middle Name:
Last Name:NEWBY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22750 WOODWARD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1753
Mailing Address - Country:US
Mailing Address - Phone:248-733-5142
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWN CTR
Practice Address - Street 2:1900
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:248-733-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor