Healthcare Provider Details

I. General information

NPI: 1154005981
Provider Name (Legal Business Name): MORGAN MECHELLE JOLLY LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD STE 900
CANTON MI
48187-2740
US

IV. Provider business mailing address

35761 SURREY CT
ROMULUS MI
48174-6334
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone: 734-444-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: