Provider Demographics
NPI:1184029001
Name:MICHELLE WAHULA, LMSW PLLC
Entity Type:Organization
Organization Name:MICHELLE WAHULA, LMSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHULA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-894-8410
Mailing Address - Street 1:228 N MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 N MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4616
Practice Address - Country:US
Practice Address - Phone:586-894-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094043261Q00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801094043OtherSTATE LICENSURE