Healthcare Provider Details

I. General information

NPI: 1952431488
Provider Name (Legal Business Name): GREGORY LAWRENCE LINDSEY SR. M.A. M DIV. CADC SAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. GREGORY LAWRENCE LINDSEY SR.

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MILWAUKEE ST
DETROIT MI
48202-2943
US

IV. Provider business mailing address

32167 HEAVENLY CT
WARREN MI
48092-3794
US

V. Phone/Fax

Practice location:
  • Phone: 313-310-5482
  • Fax: 313-267-0549
Mailing address:
  • Phone: 313-310-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: