Provider Demographics
NPI:1871892992
Name:MARSZALEC, LISA NICOLE (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:MARSZALEC
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:MARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LLPC
Mailing Address - Street 1:12800 EAST WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215
Mailing Address - Country:US
Mailing Address - Phone:313-824-8000
Mailing Address - Fax:313-824-8000
Practice Address - Street 1:12800 EAST WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215
Practice Address - Country:US
Practice Address - Phone:313-824-8000
Practice Address - Fax:313-824-8000
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health