Provider Demographics
NPI:1568740256
Name:DEJONG, JOSIE MARIA (MA LPC SCL NCC)
Entity Type:Individual
Prefix:MRS
First Name:JOSIE
Middle Name:MARIA
Last Name:DEJONG
Suffix:
Gender:F
Credentials:MA LPC SCL NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 FISK ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-9532
Mailing Address - Country:US
Mailing Address - Phone:269-240-7309
Mailing Address - Fax:269-683-1014
Practice Address - Street 1:1138 FISK ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-9532
Practice Address - Country:US
Practice Address - Phone:269-240-7309
Practice Address - Fax:269-683-1014
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010939101YP2500X
MISC0000574101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool