Individual
JESSICA LAURAINNE POULSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
677 E MAIN ST, CENTREVILLE, MI 49032-8524
(269) 467-1000
Mailing address
677 E MAIN ST, CENTREVILLE, MI 49032-8524
(269) 467-1000
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451019561
MI
Other
Enumeration date
02/17/2022
Last updated
02/17/2022
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