Provider Demographics
NPI:1205072311
Name:DEDLOFF, DAN R (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:R
Last Name:DEDLOFF
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WRIGHT AVE
Mailing Address - Street 2:P.O. BOX 69
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0069
Mailing Address - Country:US
Mailing Address - Phone:989-463-4971
Mailing Address - Fax:989-463-6515
Practice Address - Street 1:608 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-463-4971
Practice Address - Fax:989-463-6515
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional