Basic Information
| Provider Information | |||||||||
| NPI: | 1285105130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLURY-GARDNER | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | MSCJ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 E FERRY ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2628 S MILFORD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483574938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178823732 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801114007 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.