Provider Demographics
NPI:1215542733
Name:SAMONE DERKS LLC
Entity Type:Organization
Organization Name:SAMONE DERKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SAMONE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DERKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-361-1386
Mailing Address - Street 1:129 W BARAGA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4761
Mailing Address - Country:US
Mailing Address - Phone:906-361-1386
Mailing Address - Fax:906-273-1650
Practice Address - Street 1:129 W BARAGA AVE STE F
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4761
Practice Address - Country:US
Practice Address - Phone:906-361-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health