Provider Demographics
NPI:1740693464
Name:KINDRED, LISA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KINDRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16754 FORRER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3606
Mailing Address - Country:US
Mailing Address - Phone:313-874-8715
Mailing Address - Fax:
Practice Address - Street 1:16754 FORRER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3606
Practice Address - Country:US
Practice Address - Phone:313-874-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)