Provider Demographics
NPI:1457368383
Name:WINES, DAVID D (LMSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:WINES
Suffix:
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 1:20600 EUREKA RD
Mailing Address - Street 2:STE 819
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180
Mailing Address - Country:US
Mailing Address - Phone:734-285-8282
Mailing Address - Fax:734-281-0402
Practice Address - Street 1:20600 EUREKA RD
Practice Address - Street 2:STE 819
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0402
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker