Provider Demographics
NPI:1619361276
Name:HARRIS, MICHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:16645 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2206
Mailing Address - Country:US
Mailing Address - Phone:586-213-5505
Mailing Address - Fax:
Practice Address - Street 1:16645 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2206
Practice Address - Country:US
Practice Address - Phone:586-213-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010941841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical