Provider Demographics
NPI:1982341871
Name:BLAND, DARLENE HAWKINS (LMSW)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:HAWKINS
Last Name:BLAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 N PARK DR APT 1504
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4767
Mailing Address - Country:US
Mailing Address - Phone:248-229-6551
Mailing Address - Fax:
Practice Address - Street 1:16500 N PARK DR APT 1504
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4767
Practice Address - Country:US
Practice Address - Phone:248-229-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010790371041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical