Individual
MS. DIANE RUSSICK-KEGLOVITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LLPC
Contact information
Practice address
84 S SEAWAY DR, NORTON SHORES, MI 49444-3841
(231) 733-9800
Mailing address
8842 E NEWFIELD DR, HESPERIA, MI 49421-9726
(162) 956-2066
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401015994
MI
Other
Enumeration date
04/26/2017
Last updated
10/09/2023
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