Basic Information
| Provider Information | |||||||||
| NPI: | 1003143512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMBROWSKI | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N WEST AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492022179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177803316 | ||||||||
| FaxNumber: | 5177694561 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N WEST AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492022179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177803316 | ||||||||
| FaxNumber: | 5177694561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801091718 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.