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1013448059
LORETTA BANTOM
DETROIT, MI
NPI
1013448059
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: MI 6401015420)
Enumeration Date
2017-03-22
Last Update Date
2017-03-22
Business Address
-- LORETTA BANTOM
79 W ALEXANDRINE ST
DETROIT, MI 48201-2015
Phone number: 313-831-5535
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Mailing Address
-- LORETTA BANTOM
79 W ALEXANDRINE ST
DETROIT, MI 48201-2015
Phone number: 313-831-5535
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