Provider Demographics
NPI:1154989465
Name:QERAMA, EVA (LLPC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:QERAMA
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 1:110 SOUTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5184
Mailing Address - Country:US
Mailing Address - Phone:248-844-6234
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5184
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6401016733101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty