Provider Demographics
NPI:1700970381
Name:KESTERKE, CAROL JEAN (LMSW, LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:KESTERKE
Suffix:
Gender:F
Credentials:LMSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:132 TRUMBULL
Practice Address - Street 2:
Practice Address - City:ST. CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-5340
Practice Address - Fax:810-329-8964
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000039101Y00000X
MI6801032879104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS37898Medicare UPIN
MIM83680005Medicare ID - Type Unspecified