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General NPI Number Information
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NPI Number | 1124089164
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Entity Type | Individual
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Provider Name | GREGORY J DUDZINSKI MS LPC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 21751 W 11 MILE RD STE 204
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3779
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Country | US
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Telephone | 313-614-9498
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Fax | 313-930-6133
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Provider Business Mailing Address
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Address Line | 21751 W 11 MILE RD STE 204
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3779
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Country | US
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Telephone | 313-614-9498
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Fax | 313-930-6133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401009016
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License Number State | MI
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