Provider Demographics
NPI:1306320536
Name:RADTKE, KRISTIN MOCERE (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MOCERE
Last Name:RADTKE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N CONGRESS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3326
Mailing Address - Country:US
Mailing Address - Phone:231-360-5115
Mailing Address - Fax:
Practice Address - Street 1:2311 SHELBY AVE STE 106
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3849
Practice Address - Country:US
Practice Address - Phone:734-436-3233
Practice Address - Fax:734-201-1590
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional