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General NPI Number Information
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NPI Number | 1619737376
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Entity Type | Individual
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Provider Name | MS. DENISE LAVENDER JONES
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 22681 WOODWARD AVE UNIT 201114
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City | FERNDALE
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State | MI
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Zip | 48220-7052
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Country | US
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Telephone | 313-418-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 22681 WOODWARD AVE UNIT 201114
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City | FERNDALE
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State | MI
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Zip | 48220-7052
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Country | US
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Telephone | 313-418-1755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802046450
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361000976
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License Number State | MI
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