Provider Demographics
NPI:1104041466
Name:WALAINIS, JAMES ROBERT (MSW, LMSW, BCD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:WALAINIS
Suffix:
Gender:M
Credentials:MSW, LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2456
Mailing Address - Country:US
Mailing Address - Phone:248-765-4041
Mailing Address - Fax:
Practice Address - Street 1:900 WILSHIRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1634
Practice Address - Country:US
Practice Address - Phone:248-765-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010121711041C0700X
MI4101005944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist