Provider Demographics
NPI:1669478921
Name:PERSONAL & FAMILY ADJUSTMENT CENTER PC
Entity Type:Organization
Organization Name:PERSONAL & FAMILY ADJUSTMENT CENTER PC
Other - Org Name:ELM STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALVIVONIS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:248-642-8263
Mailing Address - Street 1:700 N OLD WOODWARD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1338
Mailing Address - Country:US
Mailing Address - Phone:248-642-8263
Mailing Address - Fax:248-642-3862
Practice Address - Street 1:700 N OLD WOODWARD AVE
Practice Address - Street 2:STE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1338
Practice Address - Country:US
Practice Address - Phone:248-642-8263
Practice Address - Fax:248-642-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910718OtherBCBS
MI=========OtherPPOM