Healthcare Provider Details

I. General information

NPI: 1700576139
Provider Name (Legal Business Name): ANDREAH SARAH PATSALIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WEST MAPLE RD
WALLED LAKE MI
48390-3571
US

IV. Provider business mailing address

15974 JUPITER HILLS DR
NORTHVILLE MI
48168-8628
US

V. Phone/Fax

Practice location:
  • Phone: 248-313-2900
  • Fax:
Mailing address:
  • Phone: 248-767-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: