Provider Demographics
NPI:1649732421
Name:BELL, AUDRA IRVETTE (LMSW, SSW)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:IRVETTE
Last Name:BELL
Suffix:
Gender:F
Credentials:LMSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2609
Mailing Address - Country:US
Mailing Address - Phone:248-892-5608
Mailing Address - Fax:
Practice Address - Street 1:4000 W WALTON BLVD STE A-B
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4191
Practice Address - Country:US
Practice Address - Phone:248-461-6266
Practice Address - Fax:248-461-6304
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical