Provider Demographics
NPI:1689993842
Name:FABER, KATHLEEN I (MS COUNSELING)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:I
Last Name:FABER
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 FRANCIS CT STE 220
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7769
Mailing Address - Country:US
Mailing Address - Phone:517-303-3424
Mailing Address - Fax:
Practice Address - Street 1:7804 FRANCIS CT STE 220
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7769
Practice Address - Country:US
Practice Address - Phone:517-303-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2019-06-20
Deactivation Date:2019-06-20
Deactivation Code:
Reactivation Date:2019-06-20
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401011907101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional