Provider Demographics
NPI:1477269918
Name:MOTLOCH, SHONDRA A (LPC)
Entity Type:Individual
Prefix:
First Name:SHONDRA
Middle Name:A
Last Name:MOTLOCH
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 1:38538 APPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1808
Mailing Address - Country:US
Mailing Address - Phone:586-873-3651
Mailing Address - Fax:
Practice Address - Street 1:38538 APPLEWOOD ST
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1808
Practice Address - Country:US
Practice Address - Phone:586-873-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401005652OtherAPPLY FOR NPI
MI6401005652OtherMENTAL HEALTH