Provider Demographics
NPI:1871095463
Name:PAVEL, JOANNA NOELLE (LLPC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:NOELLE
Last Name:PAVEL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 BYRD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4147
Mailing Address - Country:US
Mailing Address - Phone:313-559-3088
Mailing Address - Fax:
Practice Address - Street 1:9333 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3386
Practice Address - Country:US
Practice Address - Phone:313-406-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health