Provider Demographics
NPI:1316008089
Name:DOCTOR, ELAINE (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 EVANSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1107
Mailing Address - Country:US
Mailing Address - Phone:248-244-8644
Mailing Address - Fax:248-244-1330
Practice Address - Street 1:888 W BIG BEAVER RD STE 1450
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4762
Practice Address - Country:US
Practice Address - Phone:248-244-8644
Practice Address - Fax:248-244-1330
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional