Provider Demographics
NPI:1144769050
Name:CAROL DIANE PSAILA
Entity Type:Organization
Organization Name:CAROL DIANE PSAILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PSAILA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-358-3810
Mailing Address - Street 1:7618 BAY TREE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9572
Mailing Address - Country:US
Mailing Address - Phone:734-358-3810
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 250
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2273
Practice Address - Country:US
Practice Address - Phone:734-358-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010774341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty