Healthcare Provider Details

I. General information

NPI: 1447171939
Provider Name (Legal Business Name): SUSAN A MALONEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N POND DR STE A
WALLED LAKE MI
48390-3079
US

IV. Provider business mailing address

883 LAGUNA DR
WOLVERINE LAKE MI
48390-2016
US

V. Phone/Fax

Practice location:
  • Phone: 248-207-7513
  • Fax:
Mailing address:
  • Phone: 248-207-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN A MALONEY
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 248-207-7513