Provider Demographics
NPI:1487311197
Name:ATALLAH, JOHN (LMSW - C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ATALLAH
Suffix:
Gender:M
Credentials:LMSW - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42349 CRESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3266
Mailing Address - Country:US
Mailing Address - Phone:248-924-7042
Mailing Address - Fax:
Practice Address - Street 1:42349 CRESTVIEW CIR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3266
Practice Address - Country:US
Practice Address - Phone:248-429-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011192491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical