Provider Demographics
NPI:1891730966
Name:WAHOVIAK, DEBRA ANN (LBSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:WAHOVIAK
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:ZIGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:715 PYLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4456
Mailing Address - Country:US
Mailing Address - Phone:906-774-0522
Mailing Address - Fax:906-774-1570
Practice Address - Street 1:715 PYLE DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4456
Practice Address - Country:US
Practice Address - Phone:906-774-0522
Practice Address - Fax:906-774-1570
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802072338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
982471046235OtherPREFERRED ONE
MIDW072338OtherBCBS OF MI