Healthcare Provider Details

I. General information

NPI: 1720914492
Provider Name (Legal Business Name): NACRETIA LETISE LEMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11662 MARTIN RD
WARREN MI
48093-4588
US

IV. Provider business mailing address

1108 FAULKNER
TROY MI
48083-5459
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-6868
  • Fax: 586-558-6893
Mailing address:
  • Phone: 586-558-6868
  • Fax: 586-558-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: