Provider Demographics
NPI:1083171987
Name:DUROCHER-RADEKA, GABRIELLE L (LMSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:L
Last Name:DUROCHER-RADEKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 OSLUND RD
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-8020
Mailing Address - Country:US
Mailing Address - Phone:413-446-9699
Mailing Address - Fax:
Practice Address - Street 1:39465 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1600
Practice Address - Country:US
Practice Address - Phone:877-906-9699
Practice Address - Fax:888-483-0118
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801114448104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker