Provider Demographics
NPI:1629452941
Name:LILLEY, AMANDA (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LILLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51785 ADLER PARK DR W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2342
Mailing Address - Country:US
Mailing Address - Phone:313-410-5249
Mailing Address - Fax:
Practice Address - Street 1:42140 VAN DYKE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3677
Practice Address - Country:US
Practice Address - Phone:313-410-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010981041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical