Provider Demographics
NPI:1396022455
Name:KRISEL, DWAN LEON (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:DWAN
Middle Name:LEON
Last Name:KRISEL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44899 CENTRE CT STE 102
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5510
Mailing Address - Country:US
Mailing Address - Phone:586-794-1654
Mailing Address - Fax:586-792-1656
Practice Address - Street 1:44899 CENTRE CT STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5510
Practice Address - Country:US
Practice Address - Phone:586-794-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802083332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker