Healthcare Provider Details

I. General information

NPI: 1831962836
Provider Name (Legal Business Name): JOANNA HAYES DILLINGHAM LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S CEDAR ST
LANSING MI
48910-5461
US

IV. Provider business mailing address

4305 S CEDAR ST
LANSING MI
48910-5461
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-2762
  • Fax: 517-887-2982
Mailing address:
  • Phone: 517-887-2762
  • Fax: 517-887-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851110673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: