Provider Demographics
NPI:1881925212
Name:SUSAN L. DECKER, P.C.
Entity type:Organization
Organization Name:SUSAN L. DECKER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-646-5327
Mailing Address - Street 1:31210 PORTSIDE DR
Mailing Address - Street 2:APT 3202
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4322
Mailing Address - Country:US
Mailing Address - Phone:734-646-5327
Mailing Address - Fax:
Practice Address - Street 1:31210 PORTSIDE DR
Practice Address - Street 2:APT 3202
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4322
Practice Address - Country:US
Practice Address - Phone:734-646-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010826311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty