Provider Demographics
NPI:1861510679
Name:GREGORY, ROGER JAMES (ICADC, ICCS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:JAMES
Last Name:GREGORY
Suffix:
Gender:M
Credentials:ICADC, ICCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 WEST GRAND RIVER AVENUE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204
Mailing Address - Country:US
Mailing Address - Phone:313-834-5930
Mailing Address - Fax:313-834-4541
Practice Address - Street 1:9605 WEST GRAND RIVER
Practice Address - Street 2:NARDIN PARK RECOVERY CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204
Practice Address - Country:US
Practice Address - Phone:313-867-8015
Practice Address - Fax:313-867-8040
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)