Provider Demographics
NPI:1568639680
Name:DURDEN, ROYE KING JR (MSW LSW)
Entity Type:Individual
Prefix:
First Name:ROYE
Middle Name:KING
Last Name:DURDEN
Suffix:JR
Gender:M
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 INDIAN WOOD CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4400
Mailing Address - Country:US
Mailing Address - Phone:419-794-0567
Mailing Address - Fax:419-794-0569
Practice Address - Street 1:1645 INDIAN WOOD CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4400
Practice Address - Country:US
Practice Address - Phone:419-794-0567
Practice Address - Fax:419-794-0569
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00179421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
886495296OtherNATIONAL ASSOCIATION OF SOCIAL WORKERS
OHS0017942OtherLICENSED SOCIAL WORKER