Provider Demographics
NPI:1548637499
Name:DBT CENTER OF MICHIGAN, PLLC
Entity type:Organization
Organization Name:DBT CENTER OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE CONTRACTOR SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:734-620-7983
Mailing Address - Street 1:1876 CROSSWICK CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23975 NOVI RD STE C-101
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2459
Practice Address - Country:US
Practice Address - Phone:517-367-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management