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General NPI Number Information
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NPI Number | 1902086218
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Entity Type | Organization
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Legal Business Name | DOLUGE BEHAVIORAL SERVICES PLLC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 220 W CONGRESS ST 2ND FLOOR
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City | DETROIT
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State | MI
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Zip | 48226-3289
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Country | US
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Telephone | 313-963-4979
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W CONGRESS ST 2ND FLOOR
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City | DETROIT
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State | MI
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Zip | 48226-3289
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Country | US
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Telephone | 313-963-4979
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Fax |
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Authorized Official
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Title or Position | MSW
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Name | GLORIA JACKSON
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Credential | MSW
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Telephone | 313-963-4979
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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 | 6801019214
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License Number State | MI
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