Provider Demographics
NPI:1902350341
Name:ALBERTA, DAVID LEE (LLMSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:ALBERTA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9499 TIGER LILY DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8083
Mailing Address - Country:US
Mailing Address - Phone:616-891-2141
Mailing Address - Fax:
Practice Address - Street 1:9499 TIGER LILY DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8083
Practice Address - Country:US
Practice Address - Phone:616-891-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096595101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)