Provider Demographics
NPI:1871959213
Name:MATHER-COLCERNIAN, CATHARINE (LPC)
Entity type:Individual
Prefix:
First Name:CATHARINE
Middle Name:
Last Name:MATHER-COLCERNIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GREEN CIR
Mailing Address - Street 2:#201
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6603
Mailing Address - Country:US
Mailing Address - Phone:248-673-7090
Mailing Address - Fax:
Practice Address - Street 1:704 GREEN CIR
Practice Address - Street 2:#201
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6603
Practice Address - Country:US
Practice Address - Phone:248-673-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional