Provider Demographics
NPI:1073817110
Name:FLECK, DAWN RENEE (LISW,LICDC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RENEE
Last Name:FLECK
Suffix:
Gender:F
Credentials:LISW,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2653
Mailing Address - Country:US
Mailing Address - Phone:419-346-1552
Mailing Address - Fax:248-629-1432
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:419-346-1552
Practice Address - Fax:248-629-1432
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091094101YA0400X
OHI 00093571041C0700X
MI68010839881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)