Provider Demographics
NPI:1316555998
Name:ORCHID CORE VOC REHAB LLC
Entity Type:Organization
Organization Name:ORCHID CORE VOC REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CRC, CBIS
Authorized Official - Phone:313-588-6671
Mailing Address - Street 1:PO BOX 27716
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-0716
Mailing Address - Country:US
Mailing Address - Phone:313-588-6671
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR STE 325
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5219
Practice Address - Country:US
Practice Address - Phone:248-841-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194250837Medicaid