Provider Demographics
NPI:1275993958
Name:JAMERSON, LIA (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W MAPLE RD STE 241
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7048
Mailing Address - Country:US
Mailing Address - Phone:248-385-2320
Mailing Address - Fax:
Practice Address - Street 1:2820 W MAPLE RD
Practice Address - Street 2:SUITE 241
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-385-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional