Provider Demographics
NPI:1407687064
Name:DOBSON, MARYANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:DOBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 CREEKWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1500
Mailing Address - Country:US
Mailing Address - Phone:810-391-2923
Mailing Address - Fax:810-391-2968
Practice Address - Street 1:1091 CREEKWOOD TRL
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1500
Practice Address - Country:US
Practice Address - Phone:810-391-2923
Practice Address - Fax:810-391-2968
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010576581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical