Healthcare Provider Details

I. General information

NPI: 1326959966
Provider Name (Legal Business Name): ALISHA FAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAST ST.
HOLLY MI
48442
US

IV. Provider business mailing address

3029 BAKER HTS
GRAND BLANC MI
48507-4538
US

V. Phone/Fax

Practice location:
  • Phone: 248-494-6987
  • Fax:
Mailing address:
  • Phone: 248-494-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801110458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: