| 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 |