Healthcare Provider Details

I. General information

NPI: 1114559556
Provider Name (Legal Business Name): SHARON RENEE ROSSI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RUSSELL RD STE A&B
TECUMSEH MI
49286-2072
US

IV. Provider business mailing address

1 SEAGATE STE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 517-366-5030
  • Fax: 517-366-5034
Mailing address:
  • Phone: 567-585-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008836
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: