Provider Demographics
NPI:1053462408
Name:FLOOD-ESPINOZA, COLLEEN M (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:FLOOD-ESPINOZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25975 N KNOLLWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2632
Mailing Address - Country:US
Mailing Address - Phone:586-716-2660
Mailing Address - Fax:586-716-3095
Practice Address - Street 1:25975 N KNOLLWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2632
Practice Address - Country:US
Practice Address - Phone:586-716-2660
Practice Address - Fax:586-716-3095
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010745291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M15500Medicare ID - Type Unspecified