Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801094599 | MI |
NPI | 1003171315 |
---|---|
Provider Name | Danielle S. Lied |
First Address | Swartz Creek, MI 48473-9161 |
Second Address | Flint, MI 48503-3254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |