Healthcare Provider Details

I. General information

NPI: 1992670871
Provider Name (Legal Business Name): AUDREY REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15047 MARK TWAIN ST
DETROIT MI
48227-2917
US

IV. Provider business mailing address

15047 MARK TWAIN ST
DETROIT MI
48227-2917
US

V. Phone/Fax

Practice location:
  • Phone: 313-917-4451
  • Fax:
Mailing address:
  • Phone: 313-917-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: