Organization
WEST SIDE FAMILY MENTAL HEALTH CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADOLPH O. DI LORETO PH.D. (PRESIDENT)
(269) 637-1170
Entity
Organization
Contact information
Practice address
352 BLUE STAR HWY, BLUE STAR PROFESSIONAL BLDG., SOUTH HAVEN, MI 49090-7102
(269) 637-1170
(269) 639-1312
Mailing address
352 BLUE STAR HWY, BLUE STAR PROFESSIONAL BLDG., SOUTH HAVEN, MI 49090-7102
(269) 637-1170
(269) 639-1312
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0822
MI
Other
Enumeration date
08/21/2007
Last updated
09/06/2007
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