Healthcare Provider Details

I. General information

NPI: 1063743466
Provider Name (Legal Business Name): MRS. JULIE ANN DUPONT-MOSCHET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ANN DUPONT MA, LLPC, SAP

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15370 LEVAN RD SUITE 2
LIVONIA MI
48154-1903
US

IV. Provider business mailing address

1612 NIGHTINGALE ST
DEARBORN MI
48128-1070
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-0170
  • Fax:
Mailing address:
  • Phone: 313-585-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401007014
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: