Provider Demographics
NPI:1073103263
Name:SNEED, ALISSA QUANITA
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:QUANITA
Last Name:SNEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 TOWNER ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5723
Mailing Address - Country:US
Mailing Address - Phone:734-544-3000
Mailing Address - Fax:734-544-6176
Practice Address - Street 1:4125 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1003
Practice Address - Country:US
Practice Address - Phone:734-973-4359
Practice Address - Fax:734-973-4484
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009254103T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist