Provider Demographics
NPI:1346509932
Name:MCCALLISTER, MICHELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MCCALLISTER
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 1:290 WEST NINE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220
Mailing Address - Country:US
Mailing Address - Phone:248-677-7229
Mailing Address - Fax:
Practice Address - Street 1:290 WEST NINE MILE ROAD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:248-677-7229
Practice Address - Fax:248-541-1943
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010705001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical