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General NPI Number Information
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NPI Number | 1205579422
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Entity Type | Individual
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Provider Name | GREGORY SCOTT FRICKER
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Gender | Male
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | SAMARITAN COUNSELING CENTER OF SOUTHEAST MICHIGAN 29887 WEST ELEVEN MILE RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48842
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Country | US
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Telephone | 248-474-4701
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 ANCHOR CT
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City | HOLT
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State | MI
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Zip | 48842-8714
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Country | US
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Telephone | 734-431-2623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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