Provider Demographics
NPI:1134304751
Name:GLASS-SCHMOCK, ALISA D (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:D
Last Name:GLASS-SCHMOCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 HAMILTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1699
Mailing Address - Country:US
Mailing Address - Phone:517-375-4018
Mailing Address - Fax:
Practice Address - Street 1:2160 HAMILTON RD STE C
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1699
Practice Address - Country:US
Practice Address - Phone:517-375-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical