Basic Information
| Provider Information | |||||||||
| NPI: | 1801806864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORNSPAN | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | HEIDI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW CAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35986 FAIR OAKS CT | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484880244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9315 TELEGRAPH | ||||||||
| Address2: | |||||||||
| City: | REDFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134504500 | ||||||||
| FaxNumber: | 3134504514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801082550 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.