Provider Demographics
NPI:1841019858
Name:WARREN, DEON D JR (LLMSW)
Entity type:Individual
Prefix:
First Name:DEON
Middle Name:D
Last Name:WARREN
Suffix:JR
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 FAWN COVE LN APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4797
Mailing Address - Country:US
Mailing Address - Phone:517-763-7157
Mailing Address - Fax:
Practice Address - Street 1:418 W KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3334
Practice Address - Country:US
Practice Address - Phone:269-491-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851118941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health