Healthcare Provider Details

I. General information

NPI: 1760025811
Provider Name (Legal Business Name): MICHELLE M DAANE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 W 12 MILE RD
SOUTHFIELD MI
48076-2100
US

IV. Provider business mailing address

898 DURSLEY RD
BLOOMFIELD HILLS MI
48304-2010
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-0495
  • Fax:
Mailing address:
  • Phone: 248-866-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: