Provider Demographics
NPI:1790191690
Name:DUMAS, THERESE ANNE (MA, AODA)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:ANNE
Last Name:DUMAS
Suffix:
Gender:F
Credentials:MA, AODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 NORTH OAKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327
Mailing Address - Country:US
Mailing Address - Phone:248-406-0090
Mailing Address - Fax:
Practice Address - Street 1:1255 NORTH OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-406-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)