Provider Demographics
NPI:1154073781
Name:DEVENNY, DEMI ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:DEMI
Middle Name:ANNE
Last Name:DEVENNY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TORREY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3327
Mailing Address - Country:US
Mailing Address - Phone:810-494-7180
Mailing Address - Fax:248-692-4936
Practice Address - Street 1:53435 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-8521
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:248-692-4936
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223969101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional