Healthcare Provider Details

I. General information

NPI: 1144715558
Provider Name (Legal Business Name): DEANDREA M HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14799 DIX TOLEDO RD
SOUTHGATE MI
48195-2507
US

IV. Provider business mailing address

14799 DIX TOLEDO RD
SOUTHGATE MI
48195-2507
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-8326
  • Fax:
Mailing address:
  • Phone: 734-324-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: