Provider Demographics
NPI:1982687372
Name:LASALA, LISA GREENLEE (MSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GREENLEE
Last Name:LASALA
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:999 HAYNES ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6775
Mailing Address - Country:US
Mailing Address - Phone:248-207-1863
Mailing Address - Fax:
Practice Address - Street 1:999 HAYNES ST STE 300
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6775
Practice Address - Country:US
Practice Address - Phone:248-207-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG0778021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN59920004Medicare ID - Type Unspecified