Provider Demographics
NPI:1275278624
Name:LONERGAN, MICHELE REBECCA (LLPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:REBECCA
Last Name:LONERGAN
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 1:1043 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6867
Mailing Address - Country:US
Mailing Address - Phone:616-283-2582
Mailing Address - Fax:
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8998
Practice Address - Country:US
Practice Address - Phone:616-222-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional