Provider Demographics
NPI:1801301361
Name:VARGAS, DEVAN MICHELLE (LISW-S)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:MICHELLE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:MICHELLE
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5130 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2528
Mailing Address - Country:US
Mailing Address - Phone:419-262-0959
Mailing Address - Fax:
Practice Address - Street 1:1776 TREMAINSVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4039
Practice Address - Country:US
Practice Address - Phone:419-299-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.16003931041C0700X
OHI.20020421041C0700X
MI68011016121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical