Healthcare Provider Details

I. General information

NPI: 1144131798
Provider Name (Legal Business Name): SIRENE DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24801 5 MILE RD STE 7
REDFORD MI
48239-3653
US

IV. Provider business mailing address

PO BOX 37161
OAK PARK MI
48237-0161
US

V. Phone/Fax

Practice location:
  • Phone: 248-260-9273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851102207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: