Provider Demographics
NPI:1245353093
Name:DEBACKER, CLAUDIA MARY (MA LIP CACT)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARY
Last Name:DEBACKER
Suffix:
Gender:F
Credentials:MA LIP CACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1430
Mailing Address - Country:US
Mailing Address - Phone:313-881-9151
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:586-468-4505
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008890103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling