Doctor Name: | KATHLEEN MOUSSEAU |
NPI Number: | 1003173782 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 22455 Lakeland St Saint Clair Shores, MI - 480812323 |
Business Phone Number: | 5862162550 |
Business Fax Number: | |
Mailing Address: | 22455 Lakeland St, SAINT CLAIR SHORES |
State: | MI |
Postal Code: | 480812323 |
Phone Number: | 5862162550 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2012 |
NPI Last Update Date: | 04/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |