Provider Demographics
NPI:1679871073
Name:KEARNEY, PATRICIA ANN (LPC,LLP,CAADC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LPC,LLP,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8097 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2721
Mailing Address - Country:US
Mailing Address - Phone:313-846-5020
Mailing Address - Fax:313-846-3468
Practice Address - Street 1:8097 DECATUR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2721
Practice Address - Country:US
Practice Address - Phone:313-846-5020
Practice Address - Fax:313-846-3468
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007603101Y00000X
MI6301011435103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist