NPI | 1013090679 |
---|---|
Former Name | DEANNA RENAE ELLIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6361000635) |
Additional Taxonomies | 103T00000X Psychologist |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301010775) | |
Enumeration Date | 2006-10-24 |
Last Update Date | 2022-08-11 |