Healthcare Provider Details

I. General information

NPI: 1417612375
Provider Name (Legal Business Name): DEAIRRA TURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY STE 220
SOUTHFIELD MI
48075-2437
US

IV. Provider business mailing address

7373 POTOMAC
CENTER LINE MI
48015-1293
US

V. Phone/Fax

Practice location:
  • Phone: 248-242-5545
  • Fax:
Mailing address:
  • Phone: 313-768-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: