Provider Demographics
NPI:1730168980
Name:PRADKO, PAIGE ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:PRADKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33720 HARPER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4255
Mailing Address - Country:US
Mailing Address - Phone:586-899-0864
Mailing Address - Fax:586-294-0215
Practice Address - Street 1:33720 HARPER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-4255
Practice Address - Country:US
Practice Address - Phone:586-899-0864
Practice Address - Fax:586-294-0215
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009691101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health