Healthcare Provider Details

I. General information

NPI: 1205143633
Provider Name (Legal Business Name): NANCY BREGIER-SIRKO LPC, CSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY GRACA

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 LIVERNOIS RD STE 260
TROY MI
48083
US

IV. Provider business mailing address

110 SOUTH BLVD W STE 200
ROCHESTER HILLS MI
48307-5184
US

V. Phone/Fax

Practice location:
  • Phone: 248-464-3099
  • Fax:
Mailing address:
  • Phone: 248-844-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: