Provider Demographics
NPI:1912041344
Name:TETREAULT, DOROTHY EILEEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:EILEEN
Last Name:TETREAULT
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 1:2301 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3700
Mailing Address - Country:US
Mailing Address - Phone:571-787-8170
Mailing Address - Fax:
Practice Address - Street 1:569 WILDWOOD AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1048
Practice Address - Country:US
Practice Address - Phone:517-788-6404
Practice Address - Fax:517-787-8170
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010815791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical