Healthcare Provider Details

I. General information

NPI: 1063201267
Provider Name (Legal Business Name): ANDREW M DAILING LLMSW, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HERITAGE DR
SOUTHGATE MI
48195-3094
US

IV. Provider business mailing address

2871 WEST RD
TRENTON MI
48183-2476
US

V. Phone/Fax

Practice location:
  • Phone: 734-778-0663
  • Fax:
Mailing address:
  • Phone: 734-346-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851121655
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: