Healthcare Provider Details

I. General information

NPI: 1407509359
Provider Name (Legal Business Name): GAYLE RENEE SPRINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 748465
ATLANTA GA
30374-8465
US

IV. Provider business mailing address

14620 ROSEMARY BLVD
OAK PARK MI
48237-1934
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801116734
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: