Provider Demographics
NPI:1689840936
Name:CHARETTE, LEON THOMAS
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:THOMAS
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 CONNER ST
Mailing Address - Street 2:SUITE 1000 SOUTH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3448
Mailing Address - Country:US
Mailing Address - Phone:313-347-2054
Mailing Address - Fax:313-579-1819
Practice Address - Street 1:5555 CONNER ST
Practice Address - Street 2:SUITE 1000 SOUTH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3448
Practice Address - Country:US
Practice Address - Phone:313-347-2054
Practice Address - Fax:313-579-1819
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010806061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical