Provider Demographics
NPI:1518345545
Name:BONDALAPATI, LORI (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BONDALAPATI
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BOWERS ST UNIT 89
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7111
Mailing Address - Country:US
Mailing Address - Phone:248-907-0775
Mailing Address - Fax:
Practice Address - Street 1:888 W BIG BEAVER RD STE 780
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4745
Practice Address - Country:US
Practice Address - Phone:248-907-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03704101YA0400X
101YM0800X
MI6401016252101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518345545Medicaid