Healthcare Provider Details

I. General information

NPI: 1578838082
Provider Name (Legal Business Name): DEBRA ANN LEBLANC LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA ANN HOLM LMSW

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 COLLEGE AVE
ESCANABA MI
49829-9591
US

IV. Provider business mailing address

2820 COLLEGE AVE
ESCANABA MI
49829-9591
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1322
  • Fax: 906-233-1220
Mailing address:
  • Phone: 906-233-1322
  • Fax: 906-233-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801066470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: