Provider Demographics
NPI:1124089164
Name:DUDZINSKI, GREGORY J (MS LPC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:DUDZINSKI
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:J
Other - Last Name:DUDZINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC
Mailing Address - Street 1:21751 W 11 MILE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3779
Mailing Address - Country:US
Mailing Address - Phone:313-614-9498
Mailing Address - Fax:313-930-6133
Practice Address - Street 1:21751 W 11 MILE RD STE 204
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3779
Practice Address - Country:US
Practice Address - Phone:313-614-9498
Practice Address - Fax:313-930-6133
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional