Provider Demographics
NPI:1679672547
Name:SPRUILL, DOROTHY J (LMSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:20500 EUREKA RD
Practice Address - Street 2:#210
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6332
Practice Address - Country:US
Practice Address - Phone:734-285-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063009104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426224Medicare ID - Type Unspecified