Provider Demographics
NPI:1548334733
Name:POINDEXTER, KAREN LYNN (MSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13041 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2113
Mailing Address - Country:US
Mailing Address - Phone:248-398-8085
Mailing Address - Fax:
Practice Address - Street 1:13041 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2113
Practice Address - Country:US
Practice Address - Phone:248-398-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078961104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801078961OtherSTATE LICENSE