Healthcare Provider Details

I. General information

NPI: 1306079884
Provider Name (Legal Business Name): LISA A SHAMIE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 GRISWOLD ST STE 300
NORTHVILLE MI
48167-1690
US

IV. Provider business mailing address

PO BOX 530174
LIVONIA MI
48153-0174
US

V. Phone/Fax

Practice location:
  • Phone: 248-605-5578
  • Fax: 248-348-3410
Mailing address:
  • Phone: 248-605-5578
  • Fax: 248-348-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number204538
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067946
License Number StateMI

VIII. Authorized Official

Name: MS. LISA ANN SHAMIE
Title or Position: MEMBER
Credential: MSW, LMSW, CAAC
Phone: 248-605-5578