Healthcare Provider Details

I. General information

NPI: 1669738795
Provider Name (Legal Business Name): DAVID SCOTT DAKROUB I MS.,LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SWAN CREEK RD
IRA MI
48023-2533
US

IV. Provider business mailing address

7090 SWAN CREEK RD
IRA MI
48023-2533
US

V. Phone/Fax

Practice location:
  • Phone: 586-202-2732
  • Fax:
Mailing address:
  • Phone: 586-202-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: