Provider Demographics
NPI:1558856179
Name:MANNOR, DEBRA MARIA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MARIA
Last Name:MANNOR
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 E. FULTON
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-742-0351
Mailing Address - Fax:616-742-0370
Practice Address - Street 1:3210 EAGLE RUN DR NE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7051
Practice Address - Country:US
Practice Address - Phone:616-957-1200
Practice Address - Fax:616-957-1297
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker