Provider Demographics
NPI:1639550114
Name:LAZIN, VIORICA TIPTIS (MS MHC)
Entity Type:Individual
Prefix:
First Name:VIORICA
Middle Name:TIPTIS
Last Name:LAZIN
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 13 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1873
Mailing Address - Country:US
Mailing Address - Phone:248-298-1000
Mailing Address - Fax:248-298-1006
Practice Address - Street 1:711 W 13 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1873
Practice Address - Country:US
Practice Address - Phone:248-298-1000
Practice Address - Fax:248-298-1006
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health