Provider Demographics
NPI:1790443182
Name:FORD-DITTO, DEBORAH J (MA, LPC, CRC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:FORD-DITTO
Suffix:
Gender:F
Credentials:MA, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 SAND CRANE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9557
Mailing Address - Country:US
Mailing Address - Phone:248-739-0621
Mailing Address - Fax:
Practice Address - Street 1:11211 SAND CRANE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9557
Practice Address - Country:US
Practice Address - Phone:248-739-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007296101YM0800X, 171M00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator