Provider Demographics
NPI:1093894156
Name:MCGLOTHIN, DEATTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEATTE
Middle Name:
Last Name:MCGLOTHIN
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 1:2100 HEMMETER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3944
Mailing Address - Country:US
Mailing Address - Phone:989-799-2100
Mailing Address - Fax:989-799-2637
Practice Address - Street 1:2100 HEMMETER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3944
Practice Address - Country:US
Practice Address - Phone:989-799-2100
Practice Address - Fax:989-799-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087099104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382143740OtherTAX ID
MI730195Medicaid