Healthcare Provider Details

I. General information

NPI: 1235843400
Provider Name (Legal Business Name): MACEY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2871 WEST RD
TRENTON MI
48183-2476
US

IV. Provider business mailing address

21700 CONNEMARA DR
NORTHVILLE MI
48167-2834
US

V. Phone/Fax

Practice location:
  • Phone: 734-346-6430
  • Fax:
Mailing address:
  • Phone: 248-231-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: