Provider Demographics
NPI:1033536321
Name:ALLIX, MARY (DBH, MA, ICAADC, SAP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ALLIX
Suffix:
Gender:F
Credentials:DBH, MA, ICAADC, SAP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CRUDUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBH
Mailing Address - Street 1:PO BOX 37491
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-0491
Mailing Address - Country:US
Mailing Address - Phone:313-268-4448
Mailing Address - Fax:
Practice Address - Street 1:32811 MIDDLEBELT RD STE D
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1701
Practice Address - Country:US
Practice Address - Phone:313-268-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007949101YM0800X
261QM0850X, 261QP2300X
MIC-02275101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care