Provider Demographics
NPI:1417561291
Name:WEBB, MICAH MACHEE (LLBSW)
Entity Type:Individual
Prefix:MS
First Name:MICAH
Middle Name:MACHEE
Last Name:WEBB
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24710 WESTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-4029
Mailing Address - Country:US
Mailing Address - Phone:313-676-0038
Mailing Address - Fax:
Practice Address - Street 1:13336 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2112
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802090646104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker