Basic Information
| Provider Information | |||||||||
| NPI: | 1730190158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN-FORD | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | YVONNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW,ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25610 SHIAWASSEE RD | ||||||||
| Address2: | APT 261 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480343720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483524965 | ||||||||
| FaxNumber: | 3135761091 | ||||||||
| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | MH-11 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135763342 | ||||||||
| FaxNumber: | 3135761091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801071569 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.