Healthcare Provider Details

I. General information

NPI: 1588581516
Provider Name (Legal Business Name): LAKESIDE THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 PINE LAKE FOREST DR
LINDEN MI
48451-9092
US

IV. Provider business mailing address

16201 PINE LAKE FOREST DR
LINDEN MI
48451-9092
US

V. Phone/Fax

Practice location:
  • Phone: 810-813-1477
  • Fax:
Mailing address:
  • Phone: 810-813-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ZIOLKOWSKI
Title or Position: CO-OWNER/PSYCHOTHERAPIST
Credential: LMSW
Phone: 586-383-1055