| Profound Psychotherapy Llc | |
|
145 S Livernois Rd # 113 Rochester Hills MI 48307-1837 | |
| (248) 250-0253 | |
| Not Available |
| Full Name | Profound Psychotherapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 145 S Livernois Rd # 113, Rochester Hills, Michigan |
| Authorized Official Name and Position | Azeldri Van Der Wath (THERAPIST) |
| Authorized Official Contact | 2482502530 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Profound Psychotherapy Llc 41423 Ambercrest Dr Sterling Heights MI 48314-3719 Ph: (248) 250-0253 | Profound Psychotherapy Llc 145 S Livernois Rd # 113 Rochester Hills MI 48307-1837 Ph: (248) 250-0253 |
| NPI Number | 1376145557 |
|---|---|
| Provider Enumeration Date | 11/12/2020 |
| Last Update Date | 01/28/2021 |
| Certification Date | 01/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376145557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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