Provider Demographics
NPI:1528126521
Name:CARGO, DEBRA KAYE (ACSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAYE
Last Name:CARGO
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13387 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8965
Mailing Address - Country:US
Mailing Address - Phone:616-847-6216
Mailing Address - Fax:
Practice Address - Street 1:107 SOUTH DIVISION
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456
Practice Address - Country:US
Practice Address - Phone:616-844-0507
Practice Address - Fax:616-844-0507
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010354371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical