Provider Demographics
NPI:1023305901
Name:DANTUS, DEBORA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:
Last Name:DANTUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 COMMONS PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3986
Mailing Address - Country:US
Mailing Address - Phone:517-819-5654
Mailing Address - Fax:
Practice Address - Street 1:2172 COMMONS PKWY STE C
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3986
Practice Address - Country:US
Practice Address - Phone:517-819-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010923431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical