Provider Demographics
NPI:1083953269
Name:FLORES, DANIEL RICARDO (ADC-II, ICADC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RICARDO
Last Name:FLORES
Suffix:
Gender:M
Credentials:ADC-II, ICADC
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ADC-II, ICADC
Mailing Address - Street 1:41470 E ARCHWOOD DR
Mailing Address - Street 2:APT. A133
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4525
Mailing Address - Country:US
Mailing Address - Phone:734-672-2431
Mailing Address - Fax:313-576-1599
Practice Address - Street 1:41470 E ARCHWOOD DR
Practice Address - Street 2:APT. A133
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-4525
Practice Address - Country:US
Practice Address - Phone:734-672-2431
Practice Address - Fax:313-576-1599
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)