Individual
MR. RUSSELL LEE DORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD, LP
Contact information
Practice address
215 E MAIN ST, #201, NORTHVILLE, MI 48167-1681
(248) 348-1100
(248) 348-3410
Mailing address
215 E MAIN ST, #201, NORTHVILLE, MI 48167-1681
(248) 348-1100
(248) 348-3410
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301001278
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143449
VALUE OPTIONS
MI
01
—
68OH201330
BC/BS OF MICHIGAN
MI
Enumeration date
07/10/2007
Last updated
07/10/2007
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