Provider Demographics
NPI:1497109854
Name:SEGUIN, MARIETTE MADELEINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARIETTE
Middle Name:MADELEINE
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:SEGUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1455 S LAPEER RD STE 175N
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1467
Mailing Address - Country:US
Mailing Address - Phone:248-393-5555
Mailing Address - Fax:
Practice Address - Street 1:1455 S LAPEER RD STE 175N
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1467
Practice Address - Country:US
Practice Address - Phone:248-393-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health