Provider Demographics
NPI:1801954623
Name:DEERING, DONALD E JR (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:DEERING
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE STE 405
Mailing Address - Street 2:ST. JOSEPH MERCY OAKLAND, MEDICAL OFFICE BLDG
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5036
Mailing Address - Country:US
Mailing Address - Phone:248-335-4010
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE STE 405
Practice Address - Street 2:ST. JOSEPH MERCY OAKLAND, MEDICAL OFFICE BLDG
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5036
Practice Address - Country:US
Practice Address - Phone:248-335-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007472101YP2500X
MI6301014127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF37791012OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
MI12691550OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE INDENTIFIER