Provider Demographics
NPI:1568081222
Name:DUBOIS, ELISE (LLPC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1805
Mailing Address - Country:US
Mailing Address - Phone:248-515-4507
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:312-624-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health