Provider Demographics
NPI:1023739596
Name:STREETER, ADRIENNE MARIE (LPC, CAADC)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:MARIE
Last Name:STREETER
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721092
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0092
Mailing Address - Country:US
Mailing Address - Phone:248-910-1364
Mailing Address - Fax:
Practice Address - Street 1:18441 NADOL DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5882
Practice Address - Country:US
Practice Address - Phone:248-910-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008415101Y00000X
MIC-01766101YA0400X
MISP0000002103TS0200X
SP103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool