Provider Demographics
NPI:1942752258
Name:AZAMTARRAHIAN, ALLISON (LMSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:AZAMTARRAHIAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4660 SOUTH HAGADORN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-884-8617
Mailing Address - Fax:
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-884-8617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011001601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical