Provider Demographics
NPI:1962783662
Name:AGIUS, KORI LYNN (LMSW CAADC)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:LYNN
Last Name:AGIUS
Suffix:
Gender:F
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2211
Mailing Address - Country:US
Mailing Address - Phone:248-425-1597
Mailing Address - Fax:
Practice Address - Street 1:766 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2211
Practice Address - Country:US
Practice Address - Phone:248-425-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010932721041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical