Healthcare Provider Details

I. General information

NPI: 1518150549
Provider Name (Legal Business Name): DENNIS CLARE CRAWFORD MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S MAIN ST
PLYMOUTH MI
48170-1778
US

IV. Provider business mailing address

575 S. MAIN ST. PLYMOUTH MI 48170
PLYMOUTH MI
48170
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-7800
  • Fax:
Mailing address:
  • Phone: 734-451-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301011134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: