Provider Demographics
NPI:1568883726
Name:YUFA, IRINA
Entity Type:Individual
Prefix:MISS
First Name:IRINA
Middle Name:
Last Name:YUFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 DYEMEADOW LN.
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-814-7768
Mailing Address - Fax:810-746-5052
Practice Address - Street 1:30500 NORTHWESTEN HWY.
Practice Address - Street 2:SUITE 316
Practice Address - City:FARMINGTON HILLLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-539-8781
Practice Address - Fax:248-539-8940
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096212101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor