Healthcare Provider Details

I. General information

NPI: 1790191690
Provider Name (Legal Business Name): THERESE ANNE LANGENKAMP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

IV. Provider business mailing address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax: 248-232-6152
Mailing address:
  • Phone: 517-492-0784
  • Fax: 248-232-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: