Healthcare Provider Details

I. General information

NPI: 1013531102
Provider Name (Legal Business Name): DANIELLE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

IV. Provider business mailing address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

V. Phone/Fax

Practice location:
  • Phone: 586-501-3070
  • Fax:
Mailing address:
  • Phone: 586-501-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097261
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801097261
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: