Provider Demographics
NPI:1124065263
Name:MCGHEE, JOANN (LCSW)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74777
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-0777
Mailing Address - Country:US
Mailing Address - Phone:248-559-1763
Mailing Address - Fax:248-559-1764
Practice Address - Street 1:18101 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2649
Practice Address - Country:US
Practice Address - Phone:248-559-1763
Practice Address - Fax:248-559-1764
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI352150625OtherTAX ID
MI0M53060Medicare ID - Type Unspecified
MIR89543Medicare UPIN