Provider Demographics
NPI:1346067303
Name:SEPULVEDA, MARIA L (PHD, LPC, ACS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:PHD, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26340 BERG RD APT 416
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-8603
Mailing Address - Country:US
Mailing Address - Phone:313-243-6118
Mailing Address - Fax:
Practice Address - Street 1:26340 BERG RD APT 416
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-8603
Practice Address - Country:US
Practice Address - Phone:313-243-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional