Provider Demographics
NPI:1164529731
Name:DESROSIERS, MARLAINA C (LLPC)
Entity Type:Individual
Prefix:MS
First Name:MARLAINA
Middle Name:C
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24401 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1343
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:
Practice Address - Street 1:24401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1343
Practice Address - Country:US
Practice Address - Phone:586-783-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI537803OtherVALUE OPTIONS
MI139863SWOtherCARE CHOICES