Basic Information
| Provider Information | |||||||||
| NPI: | 1366651762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | SUSAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KISH | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | SUSAN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15241 REGINA | ||||||||
| Address2: | |||||||||
| City: | ALLEN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133862426 | ||||||||
| FaxNumber: | 7347857734 | ||||||||
| Practice Location | |||||||||
| Address1: | 13101 ALLEN RD | ||||||||
| Address2: | THE GUIDANCE CENTER | ||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857704 | ||||||||
| FaxNumber: | 7347857734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801064094 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.