Provider Demographics
NPI:1932735040
Name:GARRETT, ADESOLA (LPC)
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31175 PORTSIDE DR APT 10104
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4227
Mailing Address - Country:US
Mailing Address - Phone:248-909-3749
Mailing Address - Fax:
Practice Address - Street 1:31175 PORTSIDE DR APT 10104
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4227
Practice Address - Country:US
Practice Address - Phone:248-909-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019280101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor