Provider Demographics
NPI:1760265821
Name:LDBT, LLC
Entity Type:Organization
Organization Name:LDBT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVERDAUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-813-0271
Mailing Address - Street 1:160 N ROOSEVELT ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4894
Mailing Address - Country:US
Mailing Address - Phone:810-813-0271
Mailing Address - Fax:
Practice Address - Street 1:36216 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3002
Practice Address - Country:US
Practice Address - Phone:810-813-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty