Provider Demographics
NPI:1295039667
Name:CLEVENGER, CARA BRIANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:BRIANNE
Last Name:CLEVENGER
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 1:1078 FIRECREEK CT
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-2227
Mailing Address - Country:US
Mailing Address - Phone:734-735-5992
Mailing Address - Fax:
Practice Address - Street 1:700 STEWART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5304
Practice Address - Country:US
Practice Address - Phone:734-240-1765
Practice Address - Fax:734-240-1787
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker