Provider Demographics
NPI:1447910021
Name:ANDREWS, MARLA LYNETTE
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:LYNETTE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15572 JONAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1751
Mailing Address - Country:US
Mailing Address - Phone:734-444-8209
Mailing Address - Fax:
Practice Address - Street 1:4700 BEAUFAIT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1372
Practice Address - Country:US
Practice Address - Phone:313-267-9777
Practice Address - Fax:313-921-9131
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68030764391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6803076439Medicaid