Provider Demographics
NPI:1245001882
Name:FONSECA-NEARON, LOURDES CORINNE (LLPC)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:CORINNE
Last Name:FONSECA-NEARON
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 1:23730 ROWE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1631
Mailing Address - Country:US
Mailing Address - Phone:313-282-1340
Mailing Address - Fax:
Practice Address - Street 1:215 E BIG BEAVER RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1216
Practice Address - Country:US
Practice Address - Phone:313-451-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023476101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor