Healthcare Provider Details

I. General information

NPI: 1245195429
Provider Name (Legal Business Name): LAKEISHA TIREE PURIFOY B.A.,CADC DP, HDFS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VEVAY DR E
MASON MI
48854-9226
US

IV. Provider business mailing address

220 VEVAY DR E
MASON MI
48854-9226
US

V. Phone/Fax

Practice location:
  • Phone: 517-899-0197
  • Fax:
Mailing address:
  • Phone: 517-899-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: