Provider Demographics
NPI:1164807525
Name:CROCENZI, LISA ANN CATHERINE (LPC, NCC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:LISA ANN
Middle Name:CATHERINE
Last Name:CROCENZI
Suffix:
Gender:F
Credentials:LPC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44899 CENTRE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5510
Mailing Address - Country:US
Mailing Address - Phone:586-690-8331
Mailing Address - Fax:586-690-8401
Practice Address - Street 1:44899 CENTRE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5510
Practice Address - Country:US
Practice Address - Phone:586-690-8331
Practice Address - Fax:586-690-8401
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008008101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor