Healthcare Provider Details

I. General information

NPI: 1356686745
Provider Name (Legal Business Name): PAUL DRIPCHAK LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST
LANSING MI
48911-3800
US

IV. Provider business mailing address

301 WILLIAMSTON CENTER RD STE 800
WILLIAMSTON MI
48895-8502
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8200
  • Fax: 517-346-8011
Mailing address:
  • Phone: 517-997-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: