Basic Information
| Provider Information | |||||||||
| NPI: | 1154794311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORANT | ||||||||
| FirstName: | NALO | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132743700 | ||||||||
| FaxNumber: | 3132744900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2925 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133695300 | ||||||||
| FaxNumber: | 3133695353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2015 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 24700000X | MI | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 1041C0700X | 6801098360 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1063764033 | 05 | MI | MEDICAID |