Healthcare Provider Details

I. General information

NPI: 1740870039
Provider Name (Legal Business Name): ALISA S WILLMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 N MONROE ST
MONROE MI
48162-9297
US

IV. Provider business mailing address

26595 ROCK LAKE CT
FLAT ROCK MI
48134-8312
US

V. Phone/Fax

Practice location:
  • Phone: 734-384-3121
  • Fax:
Mailing address:
  • Phone: 917-494-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA95448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: