Provider Demographics
NPI:1871823526
Name:MOTT, RICHARD DALE
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:MOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 ARLINGTON
Mailing Address - Street 2:
Mailing Address - City:LICOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146
Mailing Address - Country:US
Mailing Address - Phone:734-785-7700
Mailing Address - Fax:
Practice Address - Street 1:1564 ARLINGTON
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:LA
Practice Address - Zip Code:48146
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor