Provider Demographics
NPI:1033203773
Name:WALATKIEWICZ, JUNE ANN (LMSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:ANN
Last Name:WALATKIEWICZ
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4249
Mailing Address - Country:US
Mailing Address - Phone:248-225-6896
Mailing Address - Fax:
Practice Address - Street 1:37875 WEST 12 MILE SUITE 203
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331
Practice Address - Country:US
Practice Address - Phone:248-225-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health