Individual
MICHELLE MARIE LISS GAITS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 320-3958
Mailing address
19185 RENSELLOR ST, LIVONIA, MI 48152-2522
(313) 320-3958
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154742997
—
MI
Enumeration date
10/15/2018
Last updated
10/15/2018
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