Provider Demographics
NPI:1639991938
Name:PAYNE, FREDERICK A (MA, LLPC)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:MR
Other - First Name:FREDDIE
Other - Middle Name:A
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:148 LEICESTER CT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1639
Mailing Address - Country:US
Mailing Address - Phone:313-559-7297
Mailing Address - Fax:
Practice Address - Street 1:148 LEICESTER CT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1639
Practice Address - Country:US
Practice Address - Phone:313-559-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023945101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor