Active NPI
Denequa Gulledge, PEER SPECIALIST
- Addiction (Substance Use Disorder) Counselor
- Detroit, MI
National Provider Identifier
1346526670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 143236940
- Practice address
- 300 W McNichols Rd
Detroit, MI 48203-2703 - Phone
- (313) 867-8015
- Fax
- (313) 867-8040
- NPI assigned
- Nov 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 143236940 | MI | Primary |
Addresses
Primary practice location
300 W McNichols Rd
Detroit, MI 48203-2703
Mailing address
300 W McNichols Rd
Detroit, MI 48203-2703
Phone (313) 867-8015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437236940 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143236940 | MI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1346526670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W MCNICHOLS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482032703",
"telephone_number": "313-867-8015",
"fax_number": "313-867-8040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W MCNICHOLS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482032703",
"telephone_number": "313-867-8015",
"fax_number": "313-867-8040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLEDGE",
"first_name": "DENEQUA",
"name_prefix": "Ms.",
"credential": "PEER SPECIALIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-01",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MI",
"license": "143236940",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1437236940",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.