Provider Demographics
NPI:1083190805
Name:MCDEVITT, JOAN EARL (LMSW/CQMHP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:EARL
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:LMSW/CQMHP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:E
Other - Last Name:MCDEVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW/CQMHP
Mailing Address - Street 1:2126 TAMIE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3626
Mailing Address - Country:US
Mailing Address - Phone:517-745-2458
Mailing Address - Fax:
Practice Address - Street 1:2126 TAMIE WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3626
Practice Address - Country:US
Practice Address - Phone:517-745-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010854921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801085492OtherMASTER'S SOCIAL WORKER LICENSE-CLINICAL LICENSE