Provider Demographics
NPI:1912058249
Name:WILLETT, ALISON ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:ROSE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S ADAMS RD
Mailing Address - Street 2:SUITE 238
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6902
Mailing Address - Country:US
Mailing Address - Phone:248-594-2080
Mailing Address - Fax:248-594-2082
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:SUITE 238
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-594-2080
Practice Address - Fax:248-594-2082
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist