Healthcare Provider Details

I. General information

NPI: 1982315768
Provider Name (Legal Business Name): DEBRA ANN LOVE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 N DIXIE HWY
MONROE MI
48162-4489
US

IV. Provider business mailing address

1035 SAINT JAMES PARK AVE
MONROE MI
48161-9084
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-3446
  • Fax:
Mailing address:
  • Phone: 734-552-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801021093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: