Provider Demographics
NPI:1558784454
Name:HARTSFIELD, JANICE DOLORES (LLMSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:DOLORES
Last Name:HARTSFIELD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15107 MINOCK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2275
Mailing Address - Country:US
Mailing Address - Phone:313-506-6536
Mailing Address - Fax:
Practice Address - Street 1:15107 MINOCK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2275
Practice Address - Country:US
Practice Address - Phone:313-506-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYH892906900OtherBLUE CARE NETWORK