Provider Demographics
NPI:1992984355
Name:SZAJNA, KIM RENEE (MA, LPC, NCC, CAADC)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RENEE
Last Name:SZAJNA
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CAADC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:RENEE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14057 MCKINNEY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2528
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010410101Y00000X, 101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health