Provider Demographics
NPI:1306255906
Name:MANDIGO, EMILY (LMSW, CCS, CAADC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MANDIGO
Suffix:
Gender:F
Credentials:LMSW, CCS, CAADC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KAMINSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CCS, CAADC
Mailing Address - Street 1:2045 E WEST MAPLE RD STE D-407
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3801
Mailing Address - Country:US
Mailing Address - Phone:248-858-7766
Mailing Address - Fax:
Practice Address - Street 1:2351 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1826
Practice Address - Country:US
Practice Address - Phone:248-853-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical