Provider Demographics
NPI:1427019819
Name:SOMERVILL, DEBRA SUE (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:SOMERVILL
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 S COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2206
Mailing Address - Country:US
Mailing Address - Phone:517-474-0747
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:1214 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2206
Practice Address - Country:US
Practice Address - Phone:517-474-0747
Practice Address - Fax:517-323-9531
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010806921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001539Medicaid
MI1001539OtherMCLAREN HEATLH ADVANTAGE
MI18245Medicaid
MI18245Medicaid