Organization
DOLUGE BEHAVIORAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA JACKSON MSW (MSW)
(313) 963-4979
Entity
Organization
Contact information
Practice address
220 W CONGRESS ST, 2ND FLOOR, DETROIT, MI 48226-3289
(313) 963-4979
Mailing address
220 W CONGRESS ST, 2ND FLOOR, DETROIT, MI 48226-3289
(313) 963-4979
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801019214
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8008971660
BLUE CROSS
MI
Enumeration date
11/05/2007
Last updated
04/20/2008
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