Provider Demographics
NPI:1528258456
Name:MIKKOLA, DAVID G (LMSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MIKKOLA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 HAYNES STREET SUITE 235
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6702
Mailing Address - Country:US
Mailing Address - Phone:586-321-0255
Mailing Address - Fax:248-677-6523
Practice Address - Street 1:999 HAYNES ST 235
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6702
Practice Address - Country:US
Practice Address - Phone:586-321-0255
Practice Address - Fax:248-677-6523
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2015-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010331411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical