Healthcare Provider Details

I. General information

NPI: 1053150789
Provider Name (Legal Business Name): MEGHAN EMMA LEDERMAN MA, LLPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

IV. Provider business mailing address

30578 SOUTHFIELD RD APT 153
SOUTHFIELD MI
48076-1225
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-6829
  • Fax:
Mailing address:
  • Phone: 248-756-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: