Provider Demographics
NPI:1790077816
Name:MCCUTCHEN, MARKITA (LPC)
Entity Type:Individual
Prefix:
First Name:MARKITA
Middle Name:
Last Name:MCCUTCHEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27405 GREENFIELD RD APT 5
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3641
Mailing Address - Country:US
Mailing Address - Phone:248-296-5905
Mailing Address - Fax:
Practice Address - Street 1:17940 FARMINGTON RD STE 302
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3159
Practice Address - Country:US
Practice Address - Phone:248-296-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012377101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional