Provider Demographics
NPI:1750979167
Name:DELAND, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:DELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9177 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277-9669
Mailing Address - Country:US
Mailing Address - Phone:810-223-8205
Mailing Address - Fax:
Practice Address - Street 1:9177 DIXON RD
Practice Address - Street 2:
Practice Address - City:RIVES JUNCTION
Practice Address - State:MI
Practice Address - Zip Code:49277-9669
Practice Address - Country:US
Practice Address - Phone:810-223-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010919031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical