Provider Demographics
NPI:1205579422
Name:FRICKER, GREGORY SCOTT
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:FRICKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 ANCHOR CT
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8714
Mailing Address - Country:US
Mailing Address - Phone:734-431-2623
Mailing Address - Fax:
Practice Address - Street 1:SAMARITAN COUNSELING CENTER OF SOUTHEAST MICHIGAN
Practice Address - Street 2:29887 WEST ELEVEN MILE RD
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48842
Practice Address - Country:US
Practice Address - Phone:248-474-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program