Provider Demographics
NPI:1093054660
Name:ELLIS-BRIGHT, MARIE-CHANTAL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE-CHANTAL
Middle Name:
Last Name:ELLIS-BRIGHT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 N MERRIMAN RD
Mailing Address - Street 2:APPARTMENT 108
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-9496
Mailing Address - Country:US
Mailing Address - Phone:734-796-4412
Mailing Address - Fax:
Practice Address - Street 1:6804 N MERRIMAN RD
Practice Address - Street 2:APPARTMENT 108
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-9496
Practice Address - Country:US
Practice Address - Phone:734-796-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker