Healthcare Provider Details

I. General information

NPI: 1013988393
Provider Name (Legal Business Name): DEBORAH ELIZABETH SEARCH WILLOUGHBY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 PALMETTO DR
PORTAGE MI
49002-3923
US

IV. Provider business mailing address

1410 TURWILL LN
KALAMAZOO MI
49006-1931
US

V. Phone/Fax

Practice location:
  • Phone: 269-327-7472
  • Fax:
Mailing address:
  • Phone: 269-349-8608
  • Fax: 269-349-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067965
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: