Provider Demographics
NPI:1649046145
Name:VENS, KAITLIN MICHELLE (LCSW - TX, LMSW- MI)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELLE
Last Name:VENS
Suffix:
Gender:F
Credentials:LCSW - TX, LMSW- MI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4624
Mailing Address - Country:US
Mailing Address - Phone:248-880-9889
Mailing Address - Fax:
Practice Address - Street 1:31815 SOUTHFIELD RD STE 18
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-480-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053561041C0700X
MI68011174021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical