Healthcare Provider Details

I. General information

NPI: 1689708521
Provider Name (Legal Business Name): DASHONTA WARREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GREENFIELD RD
DEARBORN MI
48120-1206
US

IV. Provider business mailing address

3800 GREENFIELD RD
DEARBORN MI
48120-1206
US

V. Phone/Fax

Practice location:
  • Phone: 313-326-1078
  • Fax:
Mailing address:
  • Phone: 313-961-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803085540
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6803085540
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number6803085540
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number6803085540
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number6803085540
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6803085540
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6803085540
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6803085540
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6803085540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: