Provider Demographics
NPI:1982979944
Name:NWAGURU, CYRIL T (LMSW)
Entity Type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:T
Last Name:NWAGURU
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 GREENFIELD RD
Mailing Address - Street 2:STE 210
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2581
Mailing Address - Country:US
Mailing Address - Phone:248-688-5004
Mailing Address - Fax:
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:STE 210
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-688-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health