Provider Demographics
NPI:1497758742
Name:DEGRANDE, LYNNE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:DEGRANDE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25480 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2157
Mailing Address - Country:US
Mailing Address - Phone:586-777-6800
Mailing Address - Fax:586-777-7636
Practice Address - Street 1:25480 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2157
Practice Address - Country:US
Practice Address - Phone:586-777-6800
Practice Address - Fax:586-777-7636
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68919111871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical