Healthcare Provider Details

I. General information

NPI: 1184849390
Provider Name (Legal Business Name): PATRICIA DZIECIOLOWSKI MSW,CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LEDYARD ST
DETROIT MI
48201-2641
US

IV. Provider business mailing address

31560 REGAL DR
WARREN MI
48088-2905
US

V. Phone/Fax

Practice location:
  • Phone: 313-962-9446
  • Fax: 313-962-6395
Mailing address:
  • Phone: 586-293-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberL1089826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: