Provider Demographics
NPI:1558789446
Name:DAILEY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:DAILEY PROFESSIONAL SERVICES
Other - Org Name:DIANNE L. DAILEY PH.D. PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMSW LMFT
Authorized Official - Phone:810-265-5698
Mailing Address - Street 1:5462 LAHRING RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8918
Mailing Address - Country:US
Mailing Address - Phone:810-265-5698
Mailing Address - Fax:810-735-9473
Practice Address - Street 1:5462 LAHRING RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8918
Practice Address - Country:US
Practice Address - Phone:810-265-5698
Practice Address - Fax:810-735-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010030491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty