Provider Demographics
NPI:1427118215
Name:SOCIAL PHYSICS, PLLC
Entity type:Organization
Organization Name:SOCIAL PHYSICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, QCSW
Authorized Official - Phone:313-300-2518
Mailing Address - Street 1:725 S ADAMS RD
Mailing Address - Street 2:SUITE L 134
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6902
Mailing Address - Country:US
Mailing Address - Phone:313-300-2518
Mailing Address - Fax:248-433-3384
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:SUITE L 134
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:313-300-2518
Practice Address - Fax:248-433-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P27570Medicare ID - Type UnspecifiedSOCIAL WORK