Provider Demographics
NPI:1962149005
Name:DRENT, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DRENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOBIN DR APT 6
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3500
Mailing Address - Country:US
Mailing Address - Phone:804-319-6209
Mailing Address - Fax:
Practice Address - Street 1:14930 LAPLAISANCE RD STE 127
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3878
Practice Address - Country:US
Practice Address - Phone:734-344-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2060761Medicaid