Provider Demographics
NPI:1417587189
Name:JAMES-MANN, MICHELLE (DBH, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:JAMES-MANN
Suffix:
Gender:F
Credentials:DBH, MS
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MICHELLE
Other - Last Name:JAMES-MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17187 N LAUREL PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2692
Mailing Address - Country:US
Mailing Address - Phone:734-482-1200
Mailing Address - Fax:734-482-5212
Practice Address - Street 1:5570 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9752
Practice Address - Country:US
Practice Address - Phone:734-482-1200
Practice Address - Fax:734-482-5212
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical