Provider Demographics
NPI:1083371678
Name:LUBBERS, ALYSSA A (LMSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:LUBBERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:A
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:900 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2811
Mailing Address - Country:US
Mailing Address - Phone:586-556-0681
Mailing Address - Fax:
Practice Address - Street 1:47737 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3372
Practice Address - Country:US
Practice Address - Phone:586-623-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801116864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty