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Organization

SISU MICHIGAN LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANYELLE E WAGNER LMSW, CAADC (SOCIAL WORKER/ CEO)
(989) 403-0192
Entity
Organization

Contact information

Practice address
2222 W GRAND RIVER AVE STE A, OKEMOS, MI 48864-1604
(989) 403-0192
Mailing address
1363 N GARFIELD RD, LINWOOD, MI 48634-9759
(989) 751-7854

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
06/05/2022
Last updated
06/05/2022
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