Provider Demographics
NPI:1447410055
Name:ELLINGTON DUPAS, DAISY BELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:BELLE
Last Name:ELLINGTON DUPAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAISY
Other - Middle Name:B
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:708 SAINT MARON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3983
Mailing Address - Country:US
Mailing Address - Phone:313-492-3165
Mailing Address - Fax:
Practice Address - Street 1:1959 E JEFFERSON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4125
Practice Address - Country:US
Practice Address - Phone:313-394-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional