Healthcare Provider Details

I. General information

NPI: 1184056210
Provider Name (Legal Business Name): DAYNA MICHELLE MULLALY L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD SUITE 300
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

3710 BENJAMIN AVE
ROYAL OAK MI
48073-2230
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax:
Mailing address:
  • Phone: 248-921-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094576
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: