Provider Demographics
NPI:1750659041
Name:ARNOLD, RODERICK LEE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:LEE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E HARBORTOWN DR
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5027
Mailing Address - Country:US
Mailing Address - Phone:313-719-8089
Mailing Address - Fax:
Practice Address - Street 1:250 E HARBORTOWN DR
Practice Address - Street 2:SUITE 1104
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-5027
Practice Address - Country:US
Practice Address - Phone:313-719-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010633331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical