Provider Demographics
NPI:1760061501
Name:KINGSBURY, EMILY ANN (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37166 ROBINHOOD DR APT 93
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2388
Mailing Address - Country:US
Mailing Address - Phone:248-875-2681
Mailing Address - Fax:
Practice Address - Street 1:37166 ROBINHOOD DR APT 93
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2388
Practice Address - Country:US
Practice Address - Phone:248-875-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor