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General NPI Number Information
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NPI Number | 1760514681
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Entity Type | Organization
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Legal Business Name | PAMELA CZUJ DBA PERSONAL DYNAMICS CENTER
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 23810 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-1830
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Country | US
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Telephone | 734-878-4965
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Fax | 313-563-2615
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Provider Business Mailing Address
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Address Line | 23810 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-1830
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Country | US
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Telephone | 734-878-4965
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Fax | 313-563-2615
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PAMELA ANN CZUJ
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Credential | LMSW
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Telephone | 313-563-4142
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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 | 1-00442
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801013746
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801013746
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License Number State | MI
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