Provider Demographics
NPI:1649478173
Name:PESSERL, MARINA (PHD, LPC)
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:PESSERL
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37875 W 12 MILE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3043
Mailing Address - Country:US
Mailing Address - Phone:248-910-1591
Mailing Address - Fax:248-246-1176
Practice Address - Street 1:37875 W 12 MILE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3043
Practice Address - Country:US
Practice Address - Phone:248-910-1591
Practice Address - Fax:248-246-1176
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional