Provider Demographics
NPI:1275943714
Name:DITTRICH CROLL, WENDY (MA,LLPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DITTRICH CROLL
Suffix:
Gender:F
Credentials:MA,LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3738
Mailing Address - Country:US
Mailing Address - Phone:810-360-7337
Mailing Address - Fax:
Practice Address - Street 1:306 S WASHINGTON AVE STE 226
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3833
Practice Address - Country:US
Practice Address - Phone:810-360-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional