Provider Demographics
NPI:1922534023
Name:VUKMIROVICH, DOROTHY (MS)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:VUKMIROVICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45500 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5678
Mailing Address - Country:US
Mailing Address - Phone:810-643-1713
Mailing Address - Fax:
Practice Address - Street 1:45500 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5678
Practice Address - Country:US
Practice Address - Phone:810-643-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-04989101YA0400X
MI6401224231101YP2500X
MI6401018335101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional