Provider Demographics
NPI:1851535967
Name:COUSINEAU, CONNIE CHRISTINA (LMSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:CHRISTINA
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:C
Other - Last Name:MCQUAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5303 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3800
Mailing Address - Country:US
Mailing Address - Phone:517-887-4320
Mailing Address - Fax:517-887-4403
Practice Address - Street 1:5303 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-887-4320
Practice Address - Fax:517-887-4403
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010795121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical