Provider Demographics
NPI:1619288891
Name:PODINA, JAIME SUE (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:SUE
Last Name:PODINA
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:SUE
Other - Last Name:MOZDZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:2280 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8503
Mailing Address - Country:US
Mailing Address - Phone:517-548-0081
Mailing Address - Fax:517-548-0498
Practice Address - Street 1:3760 CLEARY DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8542
Practice Address - Country:US
Practice Address - Phone:517-548-0081
Practice Address - Fax:517-548-0498
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional