Provider Demographics
NPI:1265570881
Name:DAHL, DEBRA L (PHD, LLP, LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:DAHL
Suffix:
Gender:F
Credentials:PHD, LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14951 PARK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5771
Mailing Address - Country:US
Mailing Address - Phone:586-566-6410
Mailing Address - Fax:
Practice Address - Street 1:43900 GARFIELD RD
Practice Address - Street 2:SUITE 222
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1128
Practice Address - Country:US
Practice Address - Phone:586-263-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist