Provider Demographics
NPI:1871868638
Name:LICHTMAN, JENNIFER (CAADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26703 PARKINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4029
Mailing Address - Country:US
Mailing Address - Phone:248-662-8766
Mailing Address - Fax:
Practice Address - Street 1:25200 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4473
Practice Address - Country:US
Practice Address - Phone:586-422-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02988101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)