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General NPI Number Information
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NPI Number | 1871868638
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Entity Type | Individual
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Provider Name | JENNIFER LICHTMAN CAADC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 08/03/2024
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Provider Practice Location Address
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Address Line | 25200 KELLY RD
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City | ROSEVILLE
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State | MI
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Zip | 48066-4473
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Country | US
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Telephone | 586-422-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 26703 PARKINGTON ST
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City | ROSEVILLE
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State | MI
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Zip | 48066-4029
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Country | US
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Telephone | 248-662-8766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-02988
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License Number State | MI
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