Provider Demographics
NPI:1477728160
Name:VOTRUBA, DAVID C II (PHD, LMSW, ACSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:VOTRUBA
Suffix:II
Gender:M
Credentials:PHD, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAYNARD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2440
Mailing Address - Country:US
Mailing Address - Phone:734-678-2918
Mailing Address - Fax:
Practice Address - Street 1:400 MAYNARD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2440
Practice Address - Country:US
Practice Address - Phone:734-678-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010847801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008982820OtherBCBS OF MICHIGAN