Provider Demographics
NPI:1710994926
Name:KACHOREK, LAUREN VANESSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:VANESSA
Last Name:KACHOREK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41820 6 MILE RD STE 104
Mailing Address - Street 2:ALPHA PSYCHOLOGICAL SERVICES, PC
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2771
Mailing Address - Country:US
Mailing Address - Phone:248-349-3131
Mailing Address - Fax:248-349-3232
Practice Address - Street 1:41820 6 MILE RD STE 104
Practice Address - Street 2:ALPHA PSYCHOLOGICAL SERVICES, PC
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2771
Practice Address - Country:US
Practice Address - Phone:248-349-3131
Practice Address - Fax:248-349-3232
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILK012912103T00000X
MI6301012912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical