Provider Demographics
NPI:1588837611
Name:RAGLAND, JOANNE (FOADP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:FOADP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15805 BAYLIS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3915
Mailing Address - Country:US
Mailing Address - Phone:313-365-4745
Mailing Address - Fax:
Practice Address - Street 1:15805 BAYLIS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3915
Practice Address - Country:US
Practice Address - Phone:313-341-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X101YA0400X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1411928000Medicaid