Provider Demographics
NPI:1568260412
Name:COLLEY, DRACY DEJUAN
Entity type:Individual
Prefix:MR
First Name:DRACY
Middle Name:DEJUAN
Last Name:COLLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21900 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2702
Mailing Address - Country:US
Mailing Address - Phone:248-470-6493
Mailing Address - Fax:
Practice Address - Street 1:21900 KIPLING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2702
Practice Address - Country:US
Practice Address - Phone:248-470-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator