Healthcare Provider Details

I. General information

NPI: 1376037762
Provider Name (Legal Business Name): ALLISON HERRST LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35112 W MICHIGAN AVE UNIT 1
WAYNE MI
48184-1614
US

IV. Provider business mailing address

35112 W MICHIGAN AVE UNIT 1
WAYNE MI
48184-1614
US

V. Phone/Fax

Practice location:
  • Phone: 248-938-2134
  • Fax:
Mailing address:
  • Phone: 248-938-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851116785
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: