Provider Demographics
NPI:1588842660
Name:BERMEA, ALFONSO (LPC)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:BERMEA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1652
Mailing Address - Country:US
Mailing Address - Phone:313-841-7380
Mailing Address - Fax:313-841-3730
Practice Address - Street 1:520 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3838
Practice Address - Country:US
Practice Address - Phone:810-984-4202
Practice Address - Fax:810-984-8896
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health