Healthcare Provider Details

I. General information

NPI: 1851229306
Provider Name (Legal Business Name): KANDACE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 W 7 MILE RD
DETROIT MI
48235-1335
US

IV. Provider business mailing address

15460 MAPLERIDGE ST
DETROIT MI
48205-3029
US

V. Phone/Fax

Practice location:
  • Phone: 313-418-7126
  • Fax:
Mailing address:
  • Phone: 313-418-7126
  • Fax: 313-418-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: