Individual
DR. LISA MARIE MCILVENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMIN
Contact information
Practice address
315 W LARKIN ST, MIDLAND, MI 48640
(989) 835-7511
(898) 357-5112
Mailing address
5601 HOUGHTEN DR, TROY, MI 48098-2942
(248) 879-3220
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401010105
MI
Other
Enumeration date
06/01/2007
Last updated
01/18/2021
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