Provider Demographics
NPI:1992144000
Name:VERDUN, PATRICE D (BS, LBSW, QMHP)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:D
Last Name:VERDUN
Suffix:
Gender:F
Credentials:BS, LBSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4175
Mailing Address - Country:US
Mailing Address - Phone:810-339-6394
Mailing Address - Fax:
Practice Address - Street 1:2171 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4175
Practice Address - Country:US
Practice Address - Phone:810-339-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020722801041C0700X
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical