Provider Demographics
NPI:1841647021
Name:VALDEN, ALISA (LBSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:VALDEN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 PONTIAC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2680
Mailing Address - Country:US
Mailing Address - Phone:248-209-2375
Mailing Address - Fax:248-209-2466
Practice Address - Street 1:2805 PONTIAC LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2680
Practice Address - Country:US
Practice Address - Phone:248-209-2375
Practice Address - Fax:248-209-2466
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802077376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker