Provider Demographics
NPI:1588832752
Name:KACZMAREK, EVE (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 GREATER MACK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2376
Mailing Address - Country:US
Mailing Address - Phone:586-445-1442
Mailing Address - Fax:586-445-1446
Practice Address - Street 1:22301 GREATER MACK AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2376
Practice Address - Country:US
Practice Address - Phone:586-445-1442
Practice Address - Fax:586-445-1446
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional