Provider Demographics
NPI:1659922979
Name:ALDRICH, LYDIA MAE (MA TLLP)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:MAE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41998 TRENT CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5208
Mailing Address - Country:US
Mailing Address - Phone:734-516-0775
Mailing Address - Fax:
Practice Address - Street 1:925 N LAPEER RD STE 151
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6742
Practice Address - Country:US
Practice Address - Phone:248-800-4250
Practice Address - Fax:248-268-0128
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist