Provider Demographics
NPI:1861252090
Name:MASON-HOLLIS, SUSAN (MAT, LMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MASON-HOLLIS
Suffix:
Gender:F
Credentials:MAT, LMSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:STREETMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 COACHLAMP RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48306-2720
Mailing Address - Country:US
Mailing Address - Phone:248-245-5111
Mailing Address - Fax:
Practice Address - Street 1:1200 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1032
Practice Address - Country:US
Practice Address - Phone:248-451-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical