Healthcare Provider Details

I. General information

NPI: 1316868581
Provider Name (Legal Business Name): KIMBERLY GAIL COLLEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68224 LAKE ANGELA DR
RICHMOND MI
48062-1691
US

IV. Provider business mailing address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

V. Phone/Fax

Practice location:
  • Phone: 586-242-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: