Provider Demographics
NPI:1255516878
Name:JUNE A WALATKIEWICZ LMSW ACSW LMFT PLLC
Entity type:Organization
Organization Name:JUNE A WALATKIEWICZ LMSW ACSW LMFT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALATKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW,LMFT
Authorized Official - Phone:248-225-6896
Mailing Address - Street 1:37875 W 12 MILE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3043
Mailing Address - Country:US
Mailing Address - Phone:248-225-6896
Mailing Address - Fax:
Practice Address - Street 1:37875 W 12 MILE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3043
Practice Address - Country:US
Practice Address - Phone:248-225-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP29390Medicare PIN