Provider Demographics
NPI:1508112897
Name:DUFORD, DONALD JOHN (LPC, CACI)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:DUFORD
Suffix:
Gender:M
Credentials:LPC, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16889 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-6510
Mailing Address - Country:US
Mailing Address - Phone:248-227-9725
Mailing Address - Fax:
Practice Address - Street 1:13249 PENNSYLVANIA RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6637
Practice Address - Country:US
Practice Address - Phone:734-250-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)