Provider Demographics
NPI:1376867135
Name:DESROCHER, AMY MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:DESROCHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:BAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:50630 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-4009
Mailing Address - Country:US
Mailing Address - Phone:586-949-7680
Mailing Address - Fax:586-949-7681
Practice Address - Street 1:50630 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-4009
Practice Address - Country:US
Practice Address - Phone:586-949-7680
Practice Address - Fax:586-949-7681
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101X00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor