Provider Demographics
NPI:1629520432
Name:COLASUONNO, TERESE (LLPC)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:COLASUONNO
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:MRS
Other - First Name:TERESE
Other - Middle Name:ELIZABETH
Other - Last Name:COLASUONNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC
Mailing Address - Street 1:1693 W HAMLIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3312
Mailing Address - Country:US
Mailing Address - Phone:248-299-2999
Mailing Address - Fax:248-299-2994
Practice Address - Street 1:1693 W HAMLIN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3312
Practice Address - Country:US
Practice Address - Phone:248-299-2999
Practice Address - Fax:248-299-2994
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional