Provider Demographics
NPI:1619310778
Name:FLEMING, ELIZABETH E (MA LLPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:FLEMING
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 1:5303 S CEDAR ST
Mailing Address - Street 2:BLDG. 3 ADULT HEALTH
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3800
Mailing Address - Country:US
Mailing Address - Phone:248-390-5933
Mailing Address - Fax:
Practice Address - Street 1:915 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1850
Practice Address - Country:US
Practice Address - Phone:248-390-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional