Provider Demographics
NPI:1780105841
Name:HARDEN, JACALYN (MA, LPC, PHD)
Entity type:Individual
Prefix:DR
First Name:JACALYN
Middle Name:
Last Name:HARDEN
Suffix:
Gender:F
Credentials:MA, LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2227
Mailing Address - Country:US
Mailing Address - Phone:313-550-0449
Mailing Address - Fax:
Practice Address - Street 1:32841 MIDDLEBELT RD STE 403
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1771
Practice Address - Country:US
Practice Address - Phone:248-851-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional