Provider Demographics
NPI:1891401220
Name:MORRIS, DEONDRA SR
Entity Type:Individual
Prefix:
First Name:DEONDRA
Middle Name:
Last Name:MORRIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEONDRE
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:23684 BOLAM AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4420
Mailing Address - Country:US
Mailing Address - Phone:313-624-6144
Mailing Address - Fax:
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-307-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI22670403011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical