Provider Demographics
NPI:1740771872
Name:HENDREN, DEBRA GAYLE (LICENSED BACHELOR'S)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:GAYLE
Last Name:HENDREN
Suffix:
Gender:F
Credentials:LICENSED BACHELOR'S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2227
Mailing Address - Country:US
Mailing Address - Phone:248-320-9177
Mailing Address - Fax:
Practice Address - Street 1:570 KIRTS BLVD STE 231
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4156
Practice Address - Country:US
Practice Address - Phone:248-269-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802076082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802076082OtherBACHELOR'S SOCIAL WORKER LICENSE