Provider Demographics
NPI:1629527353
Name:PETTUS, JOYYA (CERTIFIED PEER SPEC)
Entity Type:Individual
Prefix:MRS
First Name:JOYYA
Middle Name:
Last Name:PETTUS
Suffix:
Gender:F
Credentials:CERTIFIED PEER SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25153 LINDENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-6189
Mailing Address - Country:US
Mailing Address - Phone:313-681-4286
Mailing Address - Fax:
Practice Address - Street 1:882 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3710
Practice Address - Country:US
Practice Address - Phone:313-967-5320
Practice Address - Fax:313-579-5950
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health