Individual
JACQUELYN L. WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLMSW
Contact information
Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535
Mailing address
79 W ALEXANDRINE ST # MI48201, DETROIT, MI 48201-2015
(313) 831-5535
(313) 831-2608
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801102246
MI
1041C0700X
Clinical Social Worker
6801102246
MI
Other
Enumeration date
05/21/2018
Last updated
05/21/2018
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