Provider Demographics
NPI:1700395076
Name:DUDLEY, ADRIENNE E (LLPC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:E
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19445 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3361
Mailing Address - Country:US
Mailing Address - Phone:313-558-9397
Mailing Address - Fax:
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228
Practice Address - Country:US
Practice Address - Phone:313-558-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6401016060101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor