Provider Demographics
NPI:1154776003
Name:WALDROP, KAREN ALYSE (LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ALYSE
Last Name:WALDROP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ALYSE
Other - Last Name:GACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:31815 SOUTHFIELD RD STE 18
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-480-0115
Mailing Address - Fax:248-282-7114
Practice Address - Street 1:31815 SOUTHFIELD RD STE 18
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-480-0115
Practice Address - Fax:248-282-7114
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154776003Medicaid