Healthcare Provider Details

I. General information

NPI: 1902869233
Provider Name (Legal Business Name): NANCY DAHMS PETRIDES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LYNNE DAHMS MSW

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37799 PROFESSIONAL CENTER DR SUITE 106
LIVONIA MI
48154
US

IV. Provider business mailing address

37799 PROFESSIONAL CENTER DR SUITE 106
LIVONIA MI
48154
US

V. Phone/Fax

Practice location:
  • Phone: 248-343-4695
  • Fax:
Mailing address:
  • Phone: 248-343-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801033601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: