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General NPI Number Information
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NPI Number | 1952800591
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Entity Type | Individual
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Provider Name | KATHERINE KUCIEMBA MA, LLPC
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Gender | Female
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 18600 NORTHVILLE RD STE 400
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City | NORTHVILLE
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State | MI
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Zip | 48168
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Country | US
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Telephone | 248-933-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 18600 NORTHVILLE RD STE 400
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City | NORTHVILLE
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State | MI
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Zip | 48168-3555
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Country | US
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Telephone | 248-933-8595
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012246
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License Number State | MI
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