Basic Information
| Provider Information | |||||||||
| NPI: | 1821277088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISCHAKOFF | ||||||||
| FirstName: | MARAH | ||||||||
| MiddleName: | LEONIE | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2399 BUCKINGHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480721216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488609519 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29201 TELEGRAPH RD STE 550 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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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 | 101YP2500X | 6401011055 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.