Provider Demographics
NPI:1962949784
Name:ONYEMAIZU, PATVELDA (MA, LLPC)
Entity type:Individual
Prefix:
First Name:PATVELDA
Middle Name:
Last Name:ONYEMAIZU
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1754
Mailing Address - Country:US
Mailing Address - Phone:313-922-2222
Mailing Address - Fax:
Practice Address - Street 1:751 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2529
Practice Address - Country:US
Practice Address - Phone:313-922-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health