Healthcare Provider Details

I. General information

NPI: 1801959598
Provider Name (Legal Business Name): DONALD F. ULISSE M.A., LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6223 N CANTON CENTER RD
CANTON MI
48187-2696
US

IV. Provider business mailing address

6223 N CANTON CENTER RD
CANTON MI
48187-2696
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-1200
  • Fax:
Mailing address:
  • Phone: 734-975-0445
  • 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: