Defonseka, Amallie
Defonseka, Amallie is an individual health care provider with primary practice located at 114 Orchard Lake Rd , Pontiac MI 48341-2244. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Defonseka, Amallie can be contacted via phone (248) 858-7766.Contact Information
Primary practice address
114 Orchard Lake Rd
Pontiac MI 48341-2244
Phone: (248) 858-7766
Fax: (248) 858-7201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 6801086171 | Michigan |
Profile Details
| NPI number | 1306983119 |
|---|---|
| LBN Legal business name | Defonseka, Amallie |
| Credentials | LLMSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 31st, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306983119 | NPPES |
| Michigan | MEDICAID | 1883825 |
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