Provider Demographics
NPI:1902397763
Name:TRANSITIONS OF ANN ARBOR COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:TRANSITIONS OF ANN ARBOR COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-396-6271
Mailing Address - Street 1:2859 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-4110
Mailing Address - Country:US
Mailing Address - Phone:248-396-6271
Mailing Address - Fax:
Practice Address - Street 1:2859 ASHLEY LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-4110
Practice Address - Country:US
Practice Address - Phone:248-396-6271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-28
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68010807661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty