Healthcare Provider Details

I. General information

NPI: 1255426896
Provider Name (Legal Business Name): RYAN R. DYBDAHL MSW, CAC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PLACE
FLINT MI
48503
US

IV. Provider business mailing address

1619 HARBAL DRIVE
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 810-768-7561
  • Fax: 810-768-7512
Mailing address:
  • Phone: 734-996-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number102179
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801010915
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006000
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: