Provider Demographics
NPI:1093820938
Name:ALEX E. COSTINEW PH.D.,P.C.
Entity Type:Organization
Organization Name:ALEX E. COSTINEW PH.D.,P.C.
Other - Org Name:COUNSELING AND DEVELOPMENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:E
Authorized Official - Last Name:COSTINEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-588-9204
Mailing Address - Street 1:38345 W 10 MILE RD
Mailing Address - Street 2:STE 150-A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2867
Mailing Address - Country:US
Mailing Address - Phone:810-588-9204
Mailing Address - Fax:248-987-2824
Practice Address - Street 1:38345 W 10 MILE RD
Practice Address - Street 2:STE 150-A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2867
Practice Address - Country:US
Practice Address - Phone:810-588-9204
Practice Address - Fax:248-987-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006534101YP2500X
MI6301002052103T00000X
MI68010175791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34734OtherBCBS OF MI PIN