Provider Demographics
NPI:1932313426
Name:HOLBERT, JO ANNE (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JO ANNE
Middle Name:
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17352 W 12 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6311
Mailing Address - Country:US
Mailing Address - Phone:248-559-0730
Mailing Address - Fax:248-569-7626
Practice Address - Street 1:17352 W 12 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6311
Practice Address - Country:US
Practice Address - Phone:248-559-0730
Practice Address - Fax:248-569-7626
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional