Provider Demographics
NPI:1093108490
Name:SEPULVEDA, MICHELLE DIANNE (M ED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DIANNE
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:DIANNE
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:2461 FREEMANSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-5370
Mailing Address - Country:US
Mailing Address - Phone:484-903-4726
Mailing Address - Fax:
Practice Address - Street 1:2461 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-5370
Practice Address - Country:US
Practice Address - Phone:484-903-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC014672101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health