Provider Demographics
NPI:1194278176
Name:ROBERTS, DAWN (MS, LLP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26005 WHISPERING WILLOWS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9194
Mailing Address - Country:US
Mailing Address - Phone:313-995-5557
Mailing Address - Fax:
Practice Address - Street 1:4111 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-1909
Practice Address - Country:US
Practice Address - Phone:248-290-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical