Provider Demographics
NPI:1902228216
Name:PANKOTAI, DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:PANKOTAI
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 1:41921 BROOKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5227
Mailing Address - Country:US
Mailing Address - Phone:313-580-2463
Mailing Address - Fax:
Practice Address - Street 1:1333 BREWERY PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4544
Practice Address - Country:US
Practice Address - Phone:313-656-0000
Practice Address - Fax:313-656-2591
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional