Healthcare Provider Details

I. General information

NPI: 1043623283
Provider Name (Legal Business Name): LINDSEY CISSE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY DUDA LMSW

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 REECK ROAD
SOUTHGATE MI
48195-3197
US

IV. Provider business mailing address

6549 TOWN CENTER DR SUITE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 734-225-2090
  • Fax: 734-225-2091
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096795
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: