Healthcare Provider Details

I. General information

NPI: 1497109854
Provider Name (Legal Business Name): MADELEINE SEGUIN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIETTE SEGUIN MA, LPC

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

1455 S LAPEER RD STE 175N
LAKE ORION MI
48360-1467
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 248-393-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401007974
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401007974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: