Provider Demographics
NPI:1043456189
Name:FLEMING, KEITH DWIGHT (LLMSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DWIGHT
Last Name:FLEMING
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 1:8411 E. OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1390
Mailing Address - Country:US
Mailing Address - Phone:313-316-1456
Mailing Address - Fax:
Practice Address - Street 1:8411 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1390
Practice Address - Country:US
Practice Address - Phone:313-316-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010858711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical