Provider Demographics
NPI:1942962410
Name:YORK, MICHELLE K (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:YORK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45595 TIMBERLANE CT APT 202
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1142
Mailing Address - Country:US
Mailing Address - Phone:248-207-8219
Mailing Address - Fax:
Practice Address - Street 1:3111 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2962
Practice Address - Country:US
Practice Address - Phone:313-577-8610
Practice Address - Fax:313-456-9601
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010982551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical