Healthcare Provider Details

I. General information

NPI: 1649622150
Provider Name (Legal Business Name): ALLYSSA MACHNIK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

6461 CREST DR
WATERFORD MI
48329-2902
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 586-212-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801099179
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099179
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: