Provider Demographics
NPI:1063743466
Name:DUPONT-MOSCHET, JULIE ANN
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DUPONT-MOSCHET
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC, SAP
Mailing Address - Street 1:1612 NIGHTINGALE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1070
Mailing Address - Country:US
Mailing Address - Phone:313-585-3872
Mailing Address - Fax:
Practice Address - Street 1:15370 LEVAN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1903
Practice Address - Country:US
Practice Address - Phone:734-744-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007014101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor