Provider Demographics
NPI:1730190158
Name:MARTIN-FORD, JESSIE YVONNE (LMSW,ACSW)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:YVONNE
Last Name:MARTIN-FORD
Suffix:
Gender:F
Credentials:LMSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25610 SHIAWASSEE RD
Mailing Address - Street 2:APT 261
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-3720
Mailing Address - Country:US
Mailing Address - Phone:248-352-4965
Mailing Address - Fax:313-576-1091
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:MH-11
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-3342
Practice Address - Fax:313-576-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010715691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical