Provider Demographics
NPI:1306952288
Name:DUROCHER, GLORIA ILENE (LMSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ILENE
Last Name:DUROCHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KERCHEVAL AVE
Mailing Address - Street 2:390
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3629
Mailing Address - Country:US
Mailing Address - Phone:313-885-6400
Mailing Address - Fax:313-885-6807
Practice Address - Street 1:131 KERCHEVAL AVE
Practice Address - Street 2:390
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3629
Practice Address - Country:US
Practice Address - Phone:313-885-6400
Practice Address - Fax:313-885-6807
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010641281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical