Healthcare Provider Details

I. General information

NPI: 1770423097
Provider Name (Legal Business Name): DAWKINS COMMUNITY SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PARIS AVE APT 12
LINCOLN PARK MI
48146-1668
US

IV. Provider business mailing address

1470 PARIS AVE APT 12
LINCOLN PARK MI
48146-1668
US

V. Phone/Fax

Practice location:
  • Phone: 313-480-8521
  • Fax:
Mailing address:
  • Phone: 313-480-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY DAWKINS II
Title or Position: OWNER
Credential: CCHW
Phone: 313-480-8521