Provider Demographics
NPI:1275309981
Name:MCBRIDE, DALISHEANNA IRENE
Entity Type:Individual
Prefix:
First Name:DALISHEANNA
Middle Name:IRENE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35360 NANKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7224
Mailing Address - Country:US
Mailing Address - Phone:248-550-0333
Mailing Address - Fax:
Practice Address - Street 1:35360 NANKIN BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7224
Practice Address - Country:US
Practice Address - Phone:248-550-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst