Provider Demographics
NPI:1871075200
Name:SIDES, ALAN GREGORY (LLMSW-CLINICAL)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:GREGORY
Last Name:SIDES
Suffix:
Gender:M
Credentials:LLMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23345 REDMAN CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-771-0593
Mailing Address - Fax:
Practice Address - Street 1:25 S MONROE ST STE 205
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2469
Practice Address - Country:US
Practice Address - Phone:734-240-3850
Practice Address - Fax:734-240-3863
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68011044891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)