Healthcare Provider Details

I. General information

NPI: 1376672329
Provider Name (Legal Business Name): LILA BJALAND BGS, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6379 DIXIE HWY
BRIDGEPORT MI
48722-9566
US

IV. Provider business mailing address

1082 S DYE RD
FLINT MI
48532-3315
US

V. Phone/Fax

Practice location:
  • Phone: 989-777-4357
  • Fax: 989-777-7257
Mailing address:
  • Phone: 810-732-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: