Healthcare Provider Details

I. General information

NPI: 1003022922
Provider Name (Legal Business Name): DALILA JOY BEARD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ADRIAN HWY
ADRIAN MI
49221-1728
US

IV. Provider business mailing address

4871 PACKARD ST APT B3
ANN ARBOR MI
48108-1533
US

V. Phone/Fax

Practice location:
  • Phone: 517-264-1224
  • Fax:
Mailing address:
  • Phone: 517-264-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: