Provider Demographics
NPI:1932569522
Name:MINTON, DEBRA MARIE (BS,LBSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MARIE
Last Name:MINTON
Suffix:
Gender:F
Credentials:BS,LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1024
Mailing Address - Country:US
Mailing Address - Phone:734-968-1430
Mailing Address - Fax:313-237-9216
Practice Address - Street 1:1025 E. FOREST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48357
Practice Address - Country:US
Practice Address - Phone:734-968-1430
Practice Address - Fax:313-237-9216
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802073564104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker