Provider Demographics
NPI:1053030767
Name:DREWRY, JODY (LMSW)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:DREWRY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N HAVEN ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1316
Mailing Address - Country:US
Mailing Address - Phone:248-760-3736
Mailing Address - Fax:
Practice Address - Street 1:149 N HAVEN ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1316
Practice Address - Country:US
Practice Address - Phone:248-760-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010952931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical