Provider Demographics
NPI:1871868638
Name:LICHTMAN, JENNIFER (LLPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32969 HAMILTON CT
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3351
Mailing Address - Country:US
Mailing Address - Phone:248-957-6240
Mailing Address - Fax:248-957-6241
Practice Address - Street 1:32969 HAMILTON CT
Practice Address - Street 2:SUITE 125
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3351
Practice Address - Country:US
Practice Address - Phone:248-957-6240
Practice Address - Fax:248-957-6241
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012969101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional