Provider Demographics
NPI:1821505603
Name:PRESBERRY, PASSIONIQUE KENYETTA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:PASSIONIQUE
Middle Name:KENYETTA
Last Name:PRESBERRY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:PASSIONIQUE
Other - Middle Name:KENYETTA
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 189
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0434
Mailing Address - Country:US
Mailing Address - Phone:517-507-0819
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 189
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0434
Practice Address - Country:US
Practice Address - Phone:517-507-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)