Provider Demographics
NPI:1649644253
Name:WARD, DORIS EVA MAE (LPC)
Entity type:Individual
Prefix:
First Name:DORIS EVA MAE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:MAE
Other - Last Name:RENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHW; LPC
Mailing Address - Street 1:5701 BOW POINTE DR STE 315
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5402
Mailing Address - Country:US
Mailing Address - Phone:248-384-8330
Mailing Address - Fax:248-384-8331
Practice Address - Street 1:5701 BOW POINTE DR STE 315
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5402
Practice Address - Country:US
Practice Address - Phone:248-384-8330
Practice Address - Fax:248-384-8331
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011340101YP2500X
COLPC.0012275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional