Provider Demographics
NPI:1427606615
Name:COLVIN, RENE (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15734 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2716
Mailing Address - Country:US
Mailing Address - Phone:313-948-9695
Mailing Address - Fax:
Practice Address - Street 1:30101 HOOVER RD STE 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6572
Practice Address - Country:US
Practice Address - Phone:586-558-6868
Practice Address - Fax:586-558-6893
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016605101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor