Provider Demographics
NPI:1043645120
Name:LABODA, JENNIFER S (MA LLPC NCC SCL)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:LABODA
Suffix:
Gender:F
Credentials:MA LLPC NCC SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54583 JOSEPH RONALD DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2329
Mailing Address - Country:US
Mailing Address - Phone:586-322-9972
Mailing Address - Fax:
Practice Address - Street 1:54583 JOSEPH RONALD DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2329
Practice Address - Country:US
Practice Address - Phone:586-322-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012493101Y00000X
MISC0000000771196101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool