Provider Demographics
NPI:1275633901
Name:PLACIDO, JOANNE ELAINE (MA LLP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ELAINE
Last Name:PLACIDO
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 18 MILE RD APT D61
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3045
Mailing Address - Country:US
Mailing Address - Phone:586-254-1166
Mailing Address - Fax:
Practice Address - Street 1:48645 VAN DYKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-2575
Practice Address - Country:US
Practice Address - Phone:586-254-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007293103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling