Individual
MARISSA HALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17940 FARMINGTON RD, LIVONIA, MI 48152-4444
(734) 526-1878
Mailing address
11415 MAYFIELD ST, LIVONIA, MI 48150-5724
(734) 363-3458
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451022118
MI
Other
Enumeration date
06/15/2022
Last updated
06/28/2022
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