Provider Demographics
NPI:1023554540
Name:VANNESTE-KORTEBEIN, KATHLEEN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:VANNESTE-KORTEBEIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:KORTEBEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:27735 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1309
Mailing Address - Country:US
Mailing Address - Phone:586-777-8929
Mailing Address - Fax:
Practice Address - Street 1:27735 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1309
Practice Address - Country:US
Practice Address - Phone:586-777-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional