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General NPI Number Information
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NPI Number | 1699180901
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Entity Type | Organization
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Legal Business Name | LAKESHORE THERAPY PLLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 51 AUSTIN ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1244
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Country | US
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Telephone | 810-689-4846
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Fax | 810-958-1430
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Provider Business Mailing Address
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Address Line | 51 AUSTIN ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1244
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Country | US
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Telephone | 810-689-4846
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Fax | 810-958-1430
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Authorized Official
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Title or Position | OWNER, LAKESHORE THERAPY PLLC
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Name | HELENA WITKOWSKI
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Credential | LMSW, ACSW
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Telephone | 810-689-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801080601
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License Number State | MI
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