Provider Demographics
NPI:1376286799
Name:RUBIN-FORTIER, KAREN DANIELLE (LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DANIELLE
Last Name:RUBIN-FORTIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4664 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5341
Mailing Address - Country:US
Mailing Address - Phone:616-402-5516
Mailing Address - Fax:
Practice Address - Street 1:12452 STAFFORD ST STE A
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-5103
Practice Address - Country:US
Practice Address - Phone:231-798-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional