Provider Demographics
NPI:1275764995
Name:DCA BEHAVIORAL MANAGEMENT INC.
Entity Type:Organization
Organization Name:DCA BEHAVIORAL MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CHINEDU
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW
Authorized Official - Phone:989-401-1570
Mailing Address - Street 1:3195 CHRISTY WAY S STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2213
Mailing Address - Country:US
Mailing Address - Phone:989-401-1570
Mailing Address - Fax:989-401-1571
Practice Address - Street 1:3195 CHRISTY WAY S STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2213
Practice Address - Country:US
Practice Address - Phone:989-401-1570
Practice Address - Fax:989-401-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83820Medicare PIN