Basic Information
| Provider Information | |||||||||
| NPI: | 1700970381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESTERKE | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LMSW, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28000 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867530405 | ||||||||
| FaxNumber: | 5867530404 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 TRUMBULL | ||||||||
| Address2: | |||||||||
| City: | ST. CLAIR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103295340 | ||||||||
| FaxNumber: | 8103298964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101Y00000X | 6401000039 | MI | X | Behavioral Health & Social Service Providers | Counselor | 104100000X | 6801032879 | MI | X | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.