Individual
DIANA LEE FOURNIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
497 WAUKONDA AVE, BENTON HARBOR, MI 49022-3142
(269) 926-1284
Mailing address
497 WAUKONDA AVE, BENTON HARBOR, MI 49022-3142
(269) 926-1284
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0110101
—
MI
Enumeration date
03/07/2023
Last updated
03/07/2023
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