Provider Demographics
NPI:1881718906
Name:DOVE HEALTH ALLIANCE, INC.
Entity type:Organization
Organization Name:DOVE HEALTH ALLIANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BREINING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:517-783-5334
Mailing Address - Street 1:602 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-783-5334
Mailing Address - Fax:571-783-6064
Practice Address - Street 1:602 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-783-5334
Practice Address - Fax:571-783-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C80042OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1881718906OtherNPI
MI0C80042OtherBLUE CROSS BLUE SHIELD OF MICHIGAN