Provider Demographics
NPI:1639597818
Name:VADUVA, ELENA (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:VADUVA
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37677 PROFESSIONAL CENTER DR.
Mailing Address - Street 2:SUITE 135C
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-717-5398
Mailing Address - Fax:
Practice Address - Street 1:37677 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 135C
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-717-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional