Jerry Copeland, MSW, LLMSW, CAADC,
Social Worker, Clinical in Southgate, MI. Individual provider (NPI-1).
NPI number1891237186
StatusActive
Last updated in NPPESMay 22, 2024
Details
- NPI
- 1891237186
- Entity type
- Individual (NPI-1)
- Name
- Jerry Copeland
- Credential
- MSW, LLMSW, CAADC,
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 17, 2016
- Certification date
- May 22, 2024
- Last updated
- May 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 6851108144 | MI | Yes |
| 175T00000X | Peer Specialist | – | – |
Practice location
14799 Dix Toledo RdSouthgate, MI 48195-2507
Phone 734-324-8326 · Fax 734-324-8327
Mailing address
14799 Dix Toledo RdSouthgate, MI 48195-2507
Phone 734-324-8326 · Fax 313-962-6395
Other practice locations
445 Ledyard St
Detroit, MI 48201-2641
Detroit, MI 48201-2641
Phone 313-962-9446 · Fax 313-962-6395
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