Provider Demographics
NPI:1568916641
Name:ZAWILINSKI, LACI (LP PHD)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:
Last Name:ZAWILINSKI
Suffix:
Gender:F
Credentials:LP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0026
Mailing Address - Country:US
Mailing Address - Phone:248-494-8373
Mailing Address - Fax:
Practice Address - Street 1:31700 W 12 MILE RD STE 250
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4462
Practice Address - Country:US
Practice Address - Phone:248-494-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016862103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth