Provider Demographics
NPI:1538791090
Name:DOYLE, CONNIE JANE (MA LPC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:JANE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29143 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1880
Mailing Address - Country:US
Mailing Address - Phone:248-505-0073
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD STE 280
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4319
Practice Address - Country:US
Practice Address - Phone:248-505-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health