Basic Information
| Provider Information | |||||||||
| NPI: | 1023766680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZALESKI | ||||||||
| FirstName: | CRISTEN | ||||||||
| MiddleName: | ADELL | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E GRAND RIVER AVE APT B | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488432271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178833012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44000 W 12 MILE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483772646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482263013 | ||||||||
| FaxNumber: | 2483476479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2022 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6851114161 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 1023766680 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.