MEDICARE: MS. TRACEY DELONCE TAYLOR BCJ/DPCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1700581121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY DELONCE TAYLOR BCJ/DPCADC

Provider Business Mailing Address
First Line	:	17160 GRAVIER ST APT 4B
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2265
Country	:	US
Telephone Number	:	313-883-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3513
Country	:	US
Telephone Number	:	313-883-5614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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Directions to “ MS. TRACEY DELONCE TAYLOR BCJ/DPCADC” Practice Location

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