Provider Demographics
NPI:1639721061
Name:HALDER, CASSANDRA BROOKE (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:BROOKE
Last Name:HALDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3755
Mailing Address - Country:US
Mailing Address - Phone:269-425-9045
Mailing Address - Fax:
Practice Address - Street 1:2720 ALPHA ACCESS ST STE D
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3608
Practice Address - Country:US
Practice Address - Phone:269-425-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801100182Medicaid