| Doctor Name: | MALIA NOEL VASSILAKOS |
| NPI Number: | 1336472760 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 6401011130 |
| Business Practice Address: | 8774 Galbraith Rd Cheboygan, MI - 497218501 |
| Business Phone Number: | 2314201732 |
| Business Fax Number: | |
| Mailing Address: | 1634 Woiderski Rd, CHEBOYGAN |
| State: | MI |
| Postal Code: | 497218969 |
| Phone Number: | 2314201732 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2009 |
| NPI Last Update Date: | 11/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401011130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |