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General NPI Number Information
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NPI Number | 1306320064
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Entity Type | Organization
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Legal Business Name | LISA LASALA, PHD, PC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 999 HAYNES ST STE 300
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6775
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Country | US
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Telephone | 248-207-1863
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Fax |
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Provider Business Mailing Address
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Address Line | 999 HAYNES ST STE 300
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6775
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Country | US
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Telephone | 248-207-1863
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | DR. LISA LASALA
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Credential | PHD, LMSW
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Telephone | 248-207-1863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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