Provider Demographics
NPI:1649303652
Name:HUNTER, LORETHA (MA, SW)
Entity type:Individual
Prefix:MS
First Name:LORETHA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MA, SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17303 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3525
Mailing Address - Country:US
Mailing Address - Phone:313-835-3545
Mailing Address - Fax:
Practice Address - Street 1:211 GLENDALE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3231
Practice Address - Country:US
Practice Address - Phone:313-868-3223
Practice Address - Fax:313-868-8891
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI820844OtherSUBSTANCE ABUSE LICENSE