Provider Demographics
NPI:1578348181
Name:BARBA, AUBREY MARIE (LLC)
Entity Type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:MARIE
Last Name:BARBA
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48616 SULLY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9764
Mailing Address - Country:US
Mailing Address - Phone:616-422-1628
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 160
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2357
Practice Address - Country:US
Practice Address - Phone:734-929-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MI6451023174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist