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General NPI Number Information
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NPI Number | 1508112897
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Entity Type | Individual
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Provider Name | DONALD JOHN DUFORD LPC, CACI
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Gender | Male
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 13249 PENNSYLVANIA RD
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City | RIVERVIEW
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State | MI
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Zip | 48193-6637
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Country | US
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Telephone | 734-250-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 16889 CLUB DR
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City | SOUTHGATE
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State | MI
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Zip | 48195-6510
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Country | US
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Telephone | 248-227-9725
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6401005915
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License Number State | MI
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