Provider Demographics
NPI:1770940884
Name:DIANE P CUSHING LPC
Entity type:Organization
Organization Name:DIANE P CUSHING LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-680-0796
Mailing Address - Street 1:2888 E LONG LAKE RD STE 145
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7010
Mailing Address - Country:US
Mailing Address - Phone:248-680-0796
Mailing Address - Fax:248-689-0626
Practice Address - Street 1:2888 E LONG LAKE RD STE 145
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7010
Practice Address - Country:US
Practice Address - Phone:248-680-0796
Practice Address - Fax:248-689-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005517305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service