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NPI Code Detail

MEDICARE: DEMETRI CLANTON LLMSW

MEDICARE: DEMETRI CLANTON LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801101439MI

General Provider Information

NPI Number : 1982127007
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEMETRI CLANTON LLMSW
Provider Business Mailing Address
First Line : 6549 TOWN CENTER DR STE A
Second Line :
City : CLARKSTON
State : MI
Zip : 48346-4824
Country : US
Telephone Number : 248-620-6400
Fax Number :
Provider Business Practice Location Address
First Line : 2300 JOLLY OAK RD
Second Line :
City : OKEMOS
State : MI
Zip : 48864-3546
Country : US
Telephone Number : 517-679-2050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2017
Last Update Date : 06/26/2019

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