Profound Psychotherapy LLC
NPI 1376145557ActiveOrganization· Social Worker, Clinical· Rochester Hills, MI
Social Worker, Clinical in Rochester Hills, Michigan, registered in NPPES in November 2020. The authorized official on file is Azeldri Van Der Wath, LCSW, Therapist.
Overview
| NPI | 1376145557 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 12, 2020 |
| Last updated in NPPES | Jan 28, 2021 |
| Certified by provider | Jan 11, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
| Counselor | 101Y00000X | — | — |
| Social Worker | 104100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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