| NPI | 1154470755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EARNEST CAPICCHIONI Director 248-355-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301012712) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MI 6301010435) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-12-01 |