Provider Demographics
NPI:1083262844
Name:FLORES, DUSTIN JOSE (LMSW)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JOSE
Last Name:FLORES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N MANNING ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1267
Mailing Address - Country:US
Mailing Address - Phone:734-780-9449
Mailing Address - Fax:
Practice Address - Street 1:2880 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9388
Practice Address - Country:US
Practice Address - Phone:517-750-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011033481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical