Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301011134 | MI |
NPI | 1518150549 |
---|---|
Provider Name | Mr. Dennis Clare Crawford |
First Address | Detroit, MI 48201-2722 |
Second Address | Detroit, MI 48201-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 06/11/2015 |