Basic Information
| Provider Information | |||||||||
| NPI: | 1184056210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLALY | ||||||||
| FirstName: | DAYNA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | L.M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3710 BENJAMIN AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480732230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489213224 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22255 GREENFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493301 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 12/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094576 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.