Healthcare Provider Details

I. General information

NPI: 1265519631
Provider Name (Legal Business Name): DEARBORN CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 MONROE ST
DEARBORN MI
48124-3010
US

IV. Provider business mailing address

2312 MONROE ST
DEARBORN MI
48124-3010
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-1098
  • Fax:
Mailing address:
  • Phone: 313-561-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES J SNYDER
Title or Position: OWNER/PARTNER
Credential: MSW
Phone: 313-561-1098