Provider Demographics
NPI:1922534023
Name:VUKMIROVICH, DOROTHY (MS)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:VUKMIROVICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 PINEHURST ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2037
Mailing Address - Country:US
Mailing Address - Phone:586-258-6767
Mailing Address - Fax:
Practice Address - Street 1:445 LEDYARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2641
Practice Address - Country:US
Practice Address - Phone:313-962-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 324500000X
MI6401018335101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility