Provider Demographics
NPI:1093814824
Name:WOEHRLEN, PEGGY (LMSW, LMFT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:WOEHRLEN
Suffix:
Gender:F
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18090 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6251
Mailing Address - Country:US
Mailing Address - Phone:248-701-4977
Mailing Address - Fax:313-642-1998
Practice Address - Street 1:30231 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1201
Practice Address - Country:US
Practice Address - Phone:248-701-4977
Practice Address - Fax:248-723-9469
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801005123104100000X
MI4101005894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS06248Medicare UPIN
MIQ26426056Medicare ID - Type Unspecified