Provider Demographics
NPI:1871795609
Name:AGUWA, DOROTHY CHINEDU (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:CHINEDU
Last Name:AGUWA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41650 CLEMENS CIR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2864
Mailing Address - Country:US
Mailing Address - Phone:248-792-4743
Mailing Address - Fax:248-479-5500
Practice Address - Street 1:17344 W 12 MILE RD STE 207
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6321
Practice Address - Country:US
Practice Address - Phone:248-924-7439
Practice Address - Fax:248-479-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010600681041C0700X
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI475474039OtherHUMANA
MI194459OtherMERIDIAN
MI0963995OtherBLUE CROSS
MI475474039OtherHUMANA