1639276330 NPI number — DEBRA ANN SCHECK LCSW, ACSW

Table of content: MS. HEATHER KATHLEEN DAVIS CADC-1 #25-04-11458 (NPI 1790568582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639276330 NPI number — DEBRA ANN SCHECK LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHECK
Provider First Name:
DEBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639276330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3791 KLAIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48348-2359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-693-8880
Provider Business Mailing Address Fax Number:
248-391-7478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3694 CLARKSTON RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48348-5213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-693-8880
Provider Business Practice Location Address Fax Number:
248-391-7478
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801021651 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8008907620 . This is a "STATE OF MICHIGAN BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 251193 . This is a "MENTAL HEALTH NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 80020865 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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