Provider Demographics
NPI:1992076764
Name:DUSSEAU, KAREN LYNNETTE (CADC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNETTE
Last Name:DUSSEAU
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 E WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1796
Mailing Address - Country:US
Mailing Address - Phone:734-641-1141
Mailing Address - Fax:734-641-1142
Practice Address - Street 1:32715 DORSEY ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4755
Practice Address - Country:US
Practice Address - Phone:734-641-1141
Practice Address - Fax:734-641-1142
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992076764Medicaid