Healthcare Provider Details

I. General information

NPI: 1841339413
Provider Name (Legal Business Name): KATHLEEN MARIE CHARLESTON M.A., L.L.P.C.,N.C.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 HARPER AVE
SAINT CLAIR SHORES MI
48081-2240
US

IV. Provider business mailing address

35256 ROCKINGHAM DR
STERLING HEIGHTS MI
48310-4915
US

V. Phone/Fax

Practice location:
  • Phone: 586-466-6912
  • Fax: 586-466-6961
Mailing address:
  • Phone: 586-979-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009519
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802078628
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: