Provider Demographics
NPI:1457699696
Name:ALLEN-PETTWAY, STARR (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STARR
Middle Name:
Last Name:ALLEN-PETTWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:STARR
Other - Middle Name:
Other - Last Name:ALLEN-BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5929 NEWPORT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3642
Mailing Address - Country:US
Mailing Address - Phone:313-473-8001
Mailing Address - Fax:
Practice Address - Street 1:5929 NEWPORT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3642
Practice Address - Country:US
Practice Address - Phone:313-473-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084630104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker