Provider Demographics
NPI:1306012570
Name:REID, LISA MICHON (MA LBSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHON
Last Name:REID
Suffix:
Gender:F
Credentials:MA LBSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MICHON
Other - Last Name:HUNT-BUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15601 NORTHLINE
Mailing Address - Street 2:AQUINAS BLDG
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195
Mailing Address - Country:US
Mailing Address - Phone:734-785-7705
Mailing Address - Fax:
Practice Address - Street 1:15601 NORTHLINE
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-285-8035
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802074472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker