Provider Demographics
NPI:1831101286
Name:SALVATORE, ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15823 WINCHESTER
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-347-3470
Mailing Address - Fax:248-347-2242
Practice Address - Street 1:115 NORTH CENTER STREET
Practice Address - Street 2:SUITE 202 HEGIRA NORTHVILLE COUNSELING CENTER
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:248-347-2242
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006170101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor