Basic Information
| Provider Information | |||||||||
| NPI: | 1245536580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | DEANA | ||||||||
| MiddleName: | MCMAHON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA LPC, CADC-M, LBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489690641 | ||||||||
| FaxNumber: | 2489690840 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489690641 | ||||||||
| FaxNumber: | 2489690840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2011 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6802085993 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | L2470511 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.