Healthcare Provider Details

I. General information

NPI: 1386363265
Provider Name (Legal Business Name): DEJIA PLUMP LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25899 W 12 MILE RD STE 320
SOUTHFIELD MI
48034-8325
US

IV. Provider business mailing address

7412 FORRER ST
DETROIT MI
48228-3614
US

V. Phone/Fax

Practice location:
  • Phone: 248-303-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: