Provider Demographics
NPI:1265519631
Name:DEARBORN CLINICAL ASSOCIATES
Entity type:Organization
Organization Name:DEARBORN CLINICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-561-1098
Mailing Address - Street 1:2312 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3010
Mailing Address - Country:US
Mailing Address - Phone:313-561-1098
Mailing Address - Fax:
Practice Address - Street 1:2312 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3010
Practice Address - Country:US
Practice Address - Phone:313-561-1098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty