Provider Demographics
NPI:1972560357
Name:BRINKLOW, DEBRA SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:BRINKLOW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:TEADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 N. MAIN ST.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118
Mailing Address - Country:US
Mailing Address - Phone:734-645-5684
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1539
Practice Address - Country:US
Practice Address - Phone:734-645-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801032927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ44951Medicare UPIN
MIM12270051Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL