Provider Demographics
NPI:1205518974
Name:DYER, MICHAEL SR (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DYER
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5277 GREEN HILL CIR
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:MD
Mailing Address - Zip Code:21856-2053
Mailing Address - Country:US
Mailing Address - Phone:410-430-2517
Mailing Address - Fax:
Practice Address - Street 1:5277 GREEN HILL CIR
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:MD
Practice Address - Zip Code:21856-2053
Practice Address - Country:US
Practice Address - Phone:410-430-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker