Healthcare Provider Details

I. General information

NPI: 1033025945
Provider Name (Legal Business Name): AUDREY SUAREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W MAIN ST STE 400
BRIGHTON MI
48116-1559
US

IV. Provider business mailing address

19025 N FRUITPORT RD
SPRING LAKE MI
49456-1164
US

V. Phone/Fax

Practice location:
  • Phone: 810-207-5725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109166
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: