Provider Demographics
NPI:1669408829
Name:DRAKE, SUJEAN (LMSW)
Entity type:Individual
Prefix:
First Name:SUJEAN
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUJEAN
Other - Middle Name:
Other - Last Name:MEINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:239 N JEBAVY DR # A-3
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2910
Mailing Address - Country:US
Mailing Address - Phone:231-578-9524
Mailing Address - Fax:231-425-4036
Practice Address - Street 1:239 N JEBAVY DR # A-3
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2910
Practice Address - Country:US
Practice Address - Phone:231-578-9524
Practice Address - Fax:231-425-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010896671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical