Healthcare Provider Details

I. General information

NPI: 1770696908
Provider Name (Legal Business Name): JAMIL ERICKA DHUE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

28413 FRANKLIN RD
SOUTHFIELD MI
48034-5506
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax: 313-576-1014
Mailing address:
  • Phone: 248-747-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802076474
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: