Individual
MICHELLE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-5971
(517) 789-5918
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401017419
MI
Other
Enumeration date
08/22/2016
Last updated
11/06/2025
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