Provider Demographics
NPI:1043623283
Name:CISSE, LINDSEY (LMSW)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CISSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:DUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6549 TOWN CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:13305 REECK ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3197
Practice Address - Country:US
Practice Address - Phone:734-225-2090
Practice Address - Fax:734-225-2091
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010967951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical