Provider Demographics
NPI:1326823618
Name:DRAGON FLY WAY COUNSELING LLC
Entity Type:Organization
Organization Name:DRAGON FLY WAY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLANDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-586-0881
Mailing Address - Street 1:11855 N BECK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5232
Mailing Address - Country:US
Mailing Address - Phone:734-560-5797
Mailing Address - Fax:
Practice Address - Street 1:11855 N BECK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-5232
Practice Address - Country:US
Practice Address - Phone:734-560-5797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty