Healthcare Provider Details

I. General information

NPI: 1649478173
Provider Name (Legal Business Name): MARINA PESSERL PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD STE 2160
WEST BLOOMFIELD MI
48323-2192
US

IV. Provider business mailing address

5230 298TH AVE NE
CARNATION WA
98014-8401
US

V. Phone/Fax

Practice location:
  • Phone: 248-859-2457
  • Fax: 248-859-2473
Mailing address:
  • Phone: 248-910-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: