Healthcare Provider Details

I. General information

NPI: 1376859926
Provider Name (Legal Business Name): KATHERINE MARY ALBERTSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 VROOMAN RD
JACKSON MI
49201-9379
US

IV. Provider business mailing address

5455 VROOMAN RD
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-563-2161
  • Fax:
Mailing address:
  • Phone: 517-563-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010635
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number229755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: