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1790128494
ILYA V DAVIDOVICH
MONROE, MI
NPI
1790128494
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MI 6801087558)
Enumeration Date
2013-04-11
Last Update Date
2013-04-11
Business Address
-- ILYA V DAVIDOVICH LMSW
1001 S RAISINVILLE RD
MONROE, MI 48161-9754
Phone number: 734-384-0305
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Mailing Address
-- ILYA V DAVIDOVICH LMSW
5875 S IVANHOE AVE
YPSILANTI, MI 48197-7113
Phone number: 734-484-9834
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