Provider Demographics
NPI:1083732358
Name:LUSTER, JODI E (LMSW, CAC-I)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:LUSTER
Suffix:
Gender:F
Credentials:LMSW, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 2ND AVE
Mailing Address - Street 2:ALBERT KAHN BLDG. STE. 900
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2739
Mailing Address - Country:US
Mailing Address - Phone:313-456-6009
Mailing Address - Fax:313-935-9311
Practice Address - Street 1:7430 2ND AVE
Practice Address - Street 2:ALBERT KAHN BLDG. STE. 900
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2739
Practice Address - Country:US
Practice Address - Phone:313-456-6009
Practice Address - Fax:313-935-9311
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-04325101YA0400X
MI68010879681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical