Individual
BRADLEY ALLAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 396-5300
(313) 396-5353
Mailing address
4131 CLIPPERT ST, DEARBORN HEIGHTS, MI 48125-2732
(313) 680-0019
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801113780
MI
1041C0700X
Clinical Social Worker
6801113780
MI
Other
Enumeration date
08/19/2019
Last updated
07/12/2022
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