Provider Demographics
NPI:1306243225
Name:HURSEY-LEE, DEBRA T (BACHELOR)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:T
Last Name:HURSEY-LEE
Suffix:
Gender:F
Credentials:BACHELOR
Other - Prefix:MRS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:8627 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2141
Mailing Address - Country:US
Mailing Address - Phone:313-870-9372
Mailing Address - Fax:313-871-0143
Practice Address - Street 1:40 MASSACHUSETTS ST
Practice Address - Street 2:NONE
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3537
Practice Address - Country:US
Practice Address - Phone:313-731-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081452171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator