Provider Demographics
NPI:1063122380
Name:OWENS-PARISEAU, ANDREA ANGELA (LMSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANGELA
Last Name:OWENS-PARISEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ANGELA
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27621 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2951
Mailing Address - Country:US
Mailing Address - Phone:810-335-4599
Mailing Address - Fax:
Practice Address - Street 1:30472 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1844
Practice Address - Country:US
Practice Address - Phone:586-863-4000
Practice Address - Fax:586-863-4004
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011150581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801115058OtherMASTERS CLINICAL SOCIAL WORKER LICENSE