Healthcare Provider Details

I. General information

NPI: 1255267332
Provider Name (Legal Business Name): MRS. VANESHA MONIC' HUDDLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 W VIENNA RD STE D
CLIO MI
48420-2812
US

IV. Provider business mailing address

7364 CRYSTAL LAKE DR APT 2
SWARTZ CREEK MI
48473-8946
US

V. Phone/Fax

Practice location:
  • Phone: 810-938-8427
  • Fax:
Mailing address:
  • Phone: 210-797-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: