Healthcare Provider Details

I. General information

NPI: 1619760683
Provider Name (Legal Business Name): TERESA MARIE DRISCOLL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD
WARREN MI
48088-6683
US

IV. Provider business mailing address

27450 SCHOENHERR RD STE 100A
WARREN MI
48088-6686
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7825
  • Fax:
Mailing address:
  • Phone: 586-582-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118644
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: