Provider Demographics
NPI:1801364153
Name:LIVINGSTON, MICHAELA (LPC, SAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:DIEKRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SAC
Mailing Address - Street 1:PO BOX 19070
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:2449 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-4410
Practice Address - Country:US
Practice Address - Phone:715-723-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty