Provider Demographics
NPI:1235749219
Name:DEWBERRY, JOEL DARNELL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DARNELL
Last Name:DEWBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20102 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1712
Mailing Address - Country:US
Mailing Address - Phone:313-579-8272
Mailing Address - Fax:
Practice Address - Street 1:20102 HARPER AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1712
Practice Address - Country:US
Practice Address - Phone:313-579-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0823311276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit