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General NPI Number Information
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NPI Number | 1548637499
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Entity Type | Organization
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Legal Business Name | DBT CENTER OF MICHIGAN, PLLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 23975 NOVI RD STE C-101
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City | NOVI
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State | MI
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Zip | 48375-2459
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Country | US
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Telephone | 517-367-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 1876 CROSSWICK CT
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City | CANTON
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State | MI
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Zip | 48187-4689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRIVATE CONTRACTOR SOCIAL WORKER
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Name | MS. KATHLEEN SCANLON
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Credential | LLMSW
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Telephone | 734-620-7983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 104100000X
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License Number State | MI
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