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General NPI Number Information
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NPI Number | 1538430640
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Entity Type | Organization
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Legal Business Name | NANCY DOLIN DIETRICH, PH.D., LLC
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 999 HAYNES ST SUIRE 300
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6712
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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 | 999 HAYNES ST SUIRE 300
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6712
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Country | US
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Telephone | 248-723-7111
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. NANCY DOLIN DIETRICH
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Credential | PH.D.
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Telephone | 248-723-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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