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General NPI Number Information
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NPI Number | 1821803099
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Entity Type | Organization
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Legal Business Name | DEWITT FAMILY THERAPY L.L.C.
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 12830 S US HIGHWAY 27
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City | DEWITT
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State | MI
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Zip | 48820-7982
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Country | US
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Telephone | 517-488-1497
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Fax |
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Provider Business Mailing Address
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Address Line | 405 N BRIDGE ST
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City | DEWITT
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State | MI
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Zip | 48820-8907
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Country | US
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Telephone | 517-488-1497
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MR. DAVID ENTERLINE
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Credential | LMSW
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Telephone | 517-488-1497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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