Provider Demographics
NPI:1770262859
Name:RIEGEL, DAMIEN SCOTT
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:SCOTT
Last Name:RIEGEL
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 1:13300 VILLAGE PARK DR APT 2075
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2742
Mailing Address - Country:US
Mailing Address - Phone:313-539-3706
Mailing Address - Fax:
Practice Address - Street 1:9397 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-927-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009751103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling