Individual
MR. DOUGLAS JOHN DETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
1801 HICKMAN RD, DES MOINES, IA 50314-1505
(515) 282-6624
Mailing address
1235 11TH ST, #113, WEST DES MOINES, IA 50265-2118
(515) 988-1800
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11011
IA
Other
Enumeration date
10/26/2011
Last updated
10/26/2011
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