Provider Demographics
NPI:1972105344
Name:MAKELA, HOLLEY ALISE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:HOLLEY
Middle Name:ALISE
Last Name:MAKELA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20392 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-8042
Mailing Address - Country:US
Mailing Address - Phone:906-281-7187
Mailing Address - Fax:
Practice Address - Street 1:20392 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-8042
Practice Address - Country:US
Practice Address - Phone:906-281-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker