Provider Demographics
NPI:1316174550
Name:MASSEY, DARLENE R
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:R
Last Name:MASSEY
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 1:13087 E 11 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4795
Mailing Address - Country:US
Mailing Address - Phone:586-754-3060
Mailing Address - Fax:586-754-4010
Practice Address - Street 1:70 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2033
Practice Address - Country:US
Practice Address - Phone:248-338-7458
Practice Address - Fax:248-338-7513
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health