Provider Demographics
NPI:1649515404
Name:MARTIN, DEBRA JOYCE (LMSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JOYCE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30625 NADORA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7712
Mailing Address - Country:US
Mailing Address - Phone:248-252-8806
Mailing Address - Fax:248-443-1543
Practice Address - Street 1:25140 LAHSER RD STE 203A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6311
Practice Address - Country:US
Practice Address - Phone:248-252-8806
Practice Address - Fax:248-443-1543
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083977104100000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health