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General NPI Number Information
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NPI Number | 1386841807
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Entity Type | Individual
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Provider Name | NANCY DOLIN DIETRICH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 999 HAYNES ST STE 300
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6775
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Country | US
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Telephone | 248-723-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 575 PILGRIM AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1210
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Country | US
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Telephone | 248-885-1044
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801013713
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012590
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License Number State | MI
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