Provider Demographics
NPI:1285831917
Name:REMBERT, CARMEN MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MICHELLE
Last Name:REMBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18476 BLACKMOOR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3852
Mailing Address - Country:US
Mailing Address - Phone:313-974-4826
Mailing Address - Fax:
Practice Address - Street 1:1416 W. 8 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MICHIGAN
Practice Address - Zip Code:48220
Practice Address - Country:UM
Practice Address - Phone:248-399-8032
Practice Address - Fax:248-399-8042
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional