Provider Demographics
NPI:1639830821
Name:AMEGEE, FREDA OGHENERUONA (LLPC)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:OGHENERUONA
Last Name:AMEGEE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23475 LONG POINT WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3274
Mailing Address - Country:US
Mailing Address - Phone:248-752-1535
Mailing Address - Fax:
Practice Address - Street 1:44000 W 12 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2646
Practice Address - Country:US
Practice Address - Phone:248-226-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019802101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health