Provider Demographics
NPI:1659813319
Name:FLETCHER, DEANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:BURBANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 N LEROY ST STE A
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2789
Mailing Address - Country:US
Mailing Address - Phone:810-215-1414
Mailing Address - Fax:
Practice Address - Street 1:1122 N LEROY ST STE A
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2789
Practice Address - Country:US
Practice Address - Phone:810-215-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010969031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical