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General NPI Number Information
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NPI Number | 1619161940
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Entity Type | Organization
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Legal Business Name | DYNAMIC DEVELOPMENT CENTER
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 14128 BERWYN
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City | REDFORD
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State | MI
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Zip | 48239-2907
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Country | US
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Telephone | 248-557-3220
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Fax | 586-286-4739
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Provider Business Mailing Address
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Address Line | 14128 BERWYN
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City | REDFORD
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State | MI
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Zip | 48239-2907
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Country | US
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Telephone | 248-557-3220
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Fax | 586-286-4739
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. FLORENCE SCHNEBLE
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Credential | M.S.W.
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Telephone | 248-557-3220
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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 | FS058979
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License Number State | MI
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