Provider Demographics
NPI:1780613885
Name:BOND, DORELLA (PHD)
Entity type:Individual
Prefix:
First Name:DORELLA
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 KUEHNLE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2608
Mailing Address - Country:US
Mailing Address - Phone:734-660-4828
Mailing Address - Fax:734-994-9722
Practice Address - Street 1:667 KUEHNLE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2608
Practice Address - Country:US
Practice Address - Phone:734-660-4828
Practice Address - Fax:734-994-9722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F332310OtherBC/BS OF MI
CT060001850CT01OtherBC/BS OF CT
MI680F332310OtherBC/BS OF MI
MIP35520001Medicare PIN