Provider Demographics
NPI:1467933820
Name:RAGG, DAVID MARK (LMSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:RAGG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4696
Mailing Address - Country:US
Mailing Address - Phone:734-559-3540
Mailing Address - Fax:
Practice Address - Street 1:3200 W LIBERTY RD STE C2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9700
Practice Address - Country:US
Practice Address - Phone:734-559-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010884671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical