Healthcare Provider Details

I. General information

NPI: 1851102768
Provider Name (Legal Business Name): LIZA HOLLENBECK LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

IV. Provider business mailing address

3420 NIXON RD UNIT 311
ANN ARBOR MI
48105-2454
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-3471
  • Fax:
Mailing address:
  • Phone: 231-492-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6851119196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: