Provider Demographics
NPI:1558832873
Name:INTERSECTIONAL INSIGHT, PLLC
Entity Type:Organization
Organization Name:INTERSECTIONAL INSIGHT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUISE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-703-4920
Mailing Address - Street 1:26711 WOODWARD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1368
Mailing Address - Country:US
Mailing Address - Phone:248-703-4920
Mailing Address - Fax:248-458-4183
Practice Address - Street 1:26711 WOODWARD AVE STE 208
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1368
Practice Address - Country:US
Practice Address - Phone:248-703-4920
Practice Address - Fax:248-458-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty