Provider Demographics
NPI:1407255805
Name:DIANE M. CARTWRIGHT LMSW PLLC
Entity Type:Organization
Organization Name:DIANE M. CARTWRIGHT LMSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-204-7472
Mailing Address - Street 1:33717 WOODWARD AVE # 419
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0913
Mailing Address - Country:US
Mailing Address - Phone:313-204-7472
Mailing Address - Fax:248-928-1126
Practice Address - Street 1:33717 WOODWARD AVE # 419
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0913
Practice Address - Country:US
Practice Address - Phone:313-204-7472
Practice Address - Fax:248-928-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010922611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty