Provider Demographics
NPI:1548526163
Name:WADDELL, BILLIE ANNETTE (LBSW)
Entity type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:ANNETTE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BAGLEY ST
Mailing Address - Street 2:STE 1100
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1400
Mailing Address - Country:US
Mailing Address - Phone:313-961-7990
Mailing Address - Fax:313-961-1047
Practice Address - Street 1:220 BAGLEY ST
Practice Address - Street 2:STE 1100
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1400
Practice Address - Country:US
Practice Address - Phone:313-961-7990
Practice Address - Fax:313-961-1047
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802073416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker