Provider Demographics
NPI:1548665045
Name:THORIA, PUJA SHROFF (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:PUJA
Middle Name:SHROFF
Last Name:THORIA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:PUJA
Other - Middle Name:S
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3795 PALISADES BLVD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7502
Mailing Address - Country:US
Mailing Address - Phone:724-208-6421
Mailing Address - Fax:
Practice Address - Street 1:1 PARKLANE BLVD STE 1200E
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016570101YP2500X, 101Y00000X
PAPC007530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional