Basic Information
| Provider Information | |||||||||
| NPI: | 1104099100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DLUGOKINSKI | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | CORNELL | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1547 S WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481865436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347293133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1547 S WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481865436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347293133 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301006279 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.