Provider Demographics
NPI:1750950762
Name:POLMEAR, KATHERINE ALYCIA (LLPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALYCIA
Last Name:POLMEAR
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 LONGACRE CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2446
Mailing Address - Country:US
Mailing Address - Phone:248-266-5719
Mailing Address - Fax:
Practice Address - Street 1:4051 LONGACRE CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2446
Practice Address - Country:US
Practice Address - Phone:248-266-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health