Provider Demographics
NPI:1801382502
Name:DIONNE, KOURTNEY
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:DIONNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E WINDEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28139 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0910
Practice Address - Country:US
Practice Address - Phone:248-395-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2025-05-27
Deactivation Date:2020-08-25
Deactivation Code:
Reactivation Date:2020-09-01
Provider Licenses
StateLicense IDTaxonomies
MI7401002523103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst