Provider Demographics
NPI:1417361288
Name:DRITA FON LMSW
Entity Type:Organization
Organization Name:DRITA FON LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DRITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:585-201-0992
Mailing Address - Street 1:1460 WALTON BLVD STE 90A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1768
Mailing Address - Country:US
Mailing Address - Phone:586-201-0992
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD STE 90A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:586-201-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health