MEDICARE: DARYL WINTERS SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1306515358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL WINTERS SR.

Provider Business Mailing Address
First Line	:	628 PINGREE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 PINGREE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2024
Country	:	US
Telephone Number	:	313-623-4637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	09/12/2021

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Directions to “ DARYL WINTERS SR. ” Practice Location

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