Healthcare Provider Details

I. General information

NPI: 1477367365
Provider Name (Legal Business Name): BENJAMIN DAHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 SECOR RD STE 10
LAMBERTVILLE MI
48144-9456
US

IV. Provider business mailing address

18991 SANDBORN RD
MANCHESTER MI
48158-9610
US

V. Phone/Fax

Practice location:
  • Phone: 734-854-7061
  • Fax:
Mailing address:
  • Phone: 734-428-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023677
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: