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General NPI Number Information
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NPI Number | 1447171939
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Entity Type | Organization
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Legal Business Name | SUSAN A MALONEY
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 100 N POND DR STE A
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City | WALLED LAKE
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State | MI
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Zip | 48390-3079
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Country | US
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Telephone | 248-207-7513
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Fax |
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Provider Business Mailing Address
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Address Line | 883 LAGUNA DR
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City | WOLVERINE LAKE
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State | MI
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Zip | 48390-2016
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Country | US
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Telephone | 248-207-7513
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN A MALONEY
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Credential | PH.D.
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Telephone | 248-207-7513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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