Provider Demographics
NPI:1881430965
Name:AVE-LALLEMANT, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:AVE-LALLEMANT
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 1:668 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6846
Mailing Address - Country:US
Mailing Address - Phone:734-262-9385
Mailing Address - Fax:
Practice Address - Street 1:1545 KINGSWAY CT STE 207
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1952
Practice Address - Country:US
Practice Address - Phone:734-262-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health