Provider Demographics
NPI:1922427533
Name:DALTON, RAYMOND JR (MA, CAADC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:DALTON
Suffix:JR
Gender:M
Credentials:MA, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 STONY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6609
Mailing Address - Country:US
Mailing Address - Phone:734-821-0216
Mailing Address - Fax:734-821-0218
Practice Address - Street 1:320 MILLER AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3385
Practice Address - Country:US
Practice Address - Phone:734-821-0216
Practice Address - Fax:734-821-0218
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02740101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)