Provider Demographics
NPI:1023312857
Name:DELACROIX, EMERSON LANE (LLP)
Entity type:Individual
Prefix:
First Name:EMERSON
Middle Name:LANE
Last Name:DELACROIX
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N CONGRESS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3318
Mailing Address - Country:US
Mailing Address - Phone:765-426-1313
Mailing Address - Fax:
Practice Address - Street 1:704 N CONGRESS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3318
Practice Address - Country:US
Practice Address - Phone:765-426-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TP2701X, 103TC1900X
MI103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy