Provider Demographics
NPI:1033278916
Name:MICHAEL, ALICE (PHD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E WASHINGTON ST
Mailing Address - Street 2:SUTE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2062
Mailing Address - Country:US
Mailing Address - Phone:734-680-5869
Mailing Address - Fax:
Practice Address - Street 1:332 E WASHINGTON ST
Practice Address - Street 2:SUTE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2062
Practice Address - Country:US
Practice Address - Phone:734-680-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH10522OtherBCBS OF MICHIGAN