Provider Demographics
NPI:1518652387
Name:DOBRUSIN, MICHAL DANA (LLBSW)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:DANA
Last Name:DOBRUSIN
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6646
Mailing Address - Country:US
Mailing Address - Phone:734-255-9650
Mailing Address - Fax:
Practice Address - Street 1:777 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2306
Practice Address - Country:US
Practice Address - Phone:248-995-3219
Practice Address - Fax:248-397-5891
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68520910041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical