Provider Demographics
NPI:1043561731
Name:BURKE, DEBRA ANN (MA, LLP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 44TH ST SE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5323
Mailing Address - Country:US
Mailing Address - Phone:616-455-1499
Mailing Address - Fax:
Practice Address - Street 1:2180 44TH ST SE
Practice Address - Street 2:SUITE 108
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5323
Practice Address - Country:US
Practice Address - Phone:616-455-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009867103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling