Basic Information
| Provider Information | |||||||||
| NPI: | 1285006585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIPES | ||||||||
| FirstName: | CAPTORA | ||||||||
| MiddleName: | LUCY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LLPC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SNIPES | ||||||||
| OtherFirstName: | CAPTORIA | ||||||||
| OtherMiddleName: | LUCY | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 42916 SADIE LANE | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138286766 | ||||||||
| FaxNumber: | 7347298788 | ||||||||
| Practice Location | |||||||||
| Address1: | 13101 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857700 | ||||||||
| FaxNumber: | 7342871661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008468 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.