Healthcare Provider Details

I. General information

NPI: 1982544219
Provider Name (Legal Business Name): LILY THERESE ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number390200000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: