Provider Demographics
NPI:1922125806
Name:PAYNE, IRMA JEAN (LLPC)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:JEAN
Last Name:PAYNE
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 1:1892 E LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3946
Mailing Address - Country:US
Mailing Address - Phone:313-393-8865
Mailing Address - Fax:
Practice Address - Street 1:13220 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3610
Practice Address - Country:US
Practice Address - Phone:313-868-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009194101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3022440Medicaid
MI1740313238OtherCHRISTIAN GUIDANCE CENTER