Provider Demographics
NPI:1427569672
Name:TAROCKOFF, ANDREW (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:TAROCKOFF
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66773 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-1854
Mailing Address - Country:US
Mailing Address - Phone:248-410-1559
Mailing Address - Fax:248-814-0361
Practice Address - Street 1:3604 CLARKSTON RD STE 102
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5215
Practice Address - Country:US
Practice Address - Phone:248-595-9969
Practice Address - Fax:248-814-0361
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451018173101YM0800X
101YA0400X
MI6401018173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)