Healthcare Provider Details

I. General information

NPI: 1568756310
Provider Name (Legal Business Name): AMANDA E LIZOTTE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CORUNNA RD
FLINT MI
48503-3254
US

IV. Provider business mailing address

2830 CORUNNA RD
FLINT MI
48503-3254
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-6812
  • Fax: 810-234-7022
Mailing address:
  • Phone: 810-235-6812
  • Fax: 810-234-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: