Provider Demographics
NPI:1972677151
Name:REESE, DOLORES (LMSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:REESE
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 1:32270 TELEGRAPH RD
Mailing Address - Street 2:STE 240
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-593-1717
Mailing Address - Fax:248-593-1711
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:STE 240
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-593-1717
Practice Address - Fax:248-593-1711
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801046770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008975730OtherBCBS
MI0N69200Medicare ID - Type Unspecified