Individual
MISS CHASIDY COLLEEN SUMMER FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. LLP LPC
Contact information
Practice address
4287 RACE RD, LESLIE, MI 49251-9446
(517) 712-7204
(517) 796-4561
Mailing address
4287 RACE RD, LESLIE, MI 49251-9446
(517) 712-7204
(517) 796-4561
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
6401010112
MI
103TC1900X
Counseling Psychologist
Primary
6301013308
MI
Other
Enumeration date
03/20/2007
Last updated
12/20/2016
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