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General NPI Number Information
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NPI Number | 1619534534
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Entity Type | Organization
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Legal Business Name | LIAM A FAULKNER LMSW, LCC
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Dates
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Enumeration Date | 05/27/2019
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Last Update Date | 05/27/2019
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Provider Practice Location Address
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Address Line | 4572 S HAGADORN RD STE 1C
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City | EAST LANSING
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State | MI
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Zip | 48823-5385
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Country | US
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Telephone | 332-061-6841
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 HUNTINGTON RD
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City | EAST LANSING
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State | MI
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Zip | 48823-4126
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Country | US
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Telephone | 517-303-2480
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | LIAM A FAULKNER
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Credential | LMSW
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Telephone | 517-303-2480
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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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