Provider Demographics
NPI:1871856153
Name:DOMZALSKI, DANIELLE BOVEE (LLBSW, QMRP)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:BOVEE
Last Name:DOMZALSKI
Suffix:
Gender:F
Credentials:LLBSW, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2329
Mailing Address - Country:US
Mailing Address - Phone:517-548-0081
Mailing Address - Fax:517-546-1300
Practice Address - Street 1:622 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2329
Practice Address - Country:US
Practice Address - Phone:517-548-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker