Healthcare Provider Details

I. General information

NPI: 1407377443
Provider Name (Legal Business Name): CRYSTAL MARIE DEGRANDCHAMP MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42815 GARFIELD RD STE 201
CLINTON TOWNSHIP MI
48038-1143
US

IV. Provider business mailing address

42815 GARFIELD RD STE 201
CLINTON TOWNSHIP MI
48038-1143
US

V. Phone/Fax

Practice location:
  • Phone: 586-333-5328
  • Fax:
Mailing address:
  • Phone: 586-333-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401017548
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: