Healthcare Provider Details

I. General information

NPI: 1316184864
Provider Name (Legal Business Name): MARY MARGARET WYSOCKI MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

IV. Provider business mailing address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-9932
  • Fax: 248-969-0950
Mailing address:
  • Phone: 248-969-9932
  • Fax: 248-969-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401002634
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802046814
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: