Provider Demographics
NPI:1952750895
Name:BA NEW YOU COUNSELING AND WELLNESS CENTER
Entity Type:Organization
Organization Name:BA NEW YOU COUNSELING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAADC
Authorized Official - Phone:248-721-4608
Mailing Address - Street 1:19111 W 10 MILE RD
Mailing Address - Street 2:SUITE #224
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2417
Mailing Address - Country:US
Mailing Address - Phone:248-721-4608
Mailing Address - Fax:
Practice Address - Street 1:19111 W 10 MILE RD
Practice Address - Street 2:SUITE #224
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2417
Practice Address - Country:US
Practice Address - Phone:248-721-4608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009266251S00000X
MI6401014155251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health