Provider Demographics
NPI:1013136514
Name:DELEVIE, M CAREY
Entity Type:Individual
Prefix:
First Name:M
Middle Name:CAREY
Last Name:DELEVIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 WINDING RIDGE DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7558
Mailing Address - Country:US
Mailing Address - Phone:810-213-1785
Mailing Address - Fax:810-496-8539
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5627
Practice Address - Country:US
Practice Address - Phone:810-213-1785
Practice Address - Fax:810-496-8539
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health