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General NPI Number Information
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NPI Number | 1275119307
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Entity Type | Organization
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Legal Business Name | DOCKSIDE THERAPY PLLC
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 46800 JANS DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5126
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Country | US
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Telephone | 586-917-6612
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Fax | 313-509-3967
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Provider Business Mailing Address
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Address Line | 46800 JANS DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5126
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Country | US
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Telephone | 586-917-6612
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Fax | 313-509-3967
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Authorized Official
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Title or Position | OWNER, CEO PSYCHOTHERAPIST
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Name | BRITTANY M SHERMAN
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Credential | LMSW
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Telephone | 586-917-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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